AC 4342 Pull. Health M Hol 33 The Metropolitan Borough of Bolborn. ANNUAL REPORT OF THE Medical Officer of Health, For the Year 1935. Londan: Feinted by DIPROSE, BATEiMAN k CO., Sheffield Street, Kingsw»y, W.C.2. 1936 The Metropolitan Borough of Bolborn. ANNUAL REPORT OF THE Medical Officer of Health, For the Year 1935. Londan: Prinded by DIPROSE, BATEMAN & CO., Sheffield Street, Kingsway, W.C.2. 1936 PUBLIC HEALTH DEPARTMENT, TOWN HALL, 197, HIGH HOLBORN, W.C.1. July, 1936. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Holborn. Your Worship, Ladies and Gentlemen, Herewith I beg to present a report upon the health and sanitary conditions of the Borough for the year 1935. I am, Your obedient Servant, J. A. STRUTHERS, Medical Officer of Health. INDEX. Page Public Health Committee 6 Housing of the Working Classes Committee 6 Maternity and Child Welfare Committee 7 Tuberculosis Care Committee 7 Staff 7 Statistics and Social Conditions Statistical Summary 9 Vital Statistics 9 Births 10 Deaths 10 Infantile Mortality 11 Deaths in Public Institutions 12 General Provision of Health Services 12 Sanitary Circumstances Removal of Offal 17 Removal of Manure 17 Sanitary Inspection of District 18 Notices served 19 By-laws as to Houses let in Lodgings 21 Rag and Bone Dealers 21 Rats and Mice (Destruction) Act, 1919 21 National Rat Week 23 Drainage Work, Supervision of 23 Smoke Abatement 23 Inspection of Workshop 24 Factories 24 Outworkers 26 Rag Flock Acts 26 Shops Acts 26 Inspection of Private Swimming Baths 27 Housing Statistics 27 Common Lodging Houses 28 Housing Accommodation on L.C.C. Estates 29 Holborn Housing Trust, Ltd. 29 Overcrowding Survey 30 Overcrowding in Municipal Housing Estates 31 New Houses Required 31 Abatement of Overcrowding 32 Re-Honsing 32 Inspection and Supervision of Food. Dairies, Cowsheds and Milk Shops 32 Milk (Special Designations) Order, 1923 33 Milk—Bacteriological Examination 33 Cleanliness of Milk 33 Dried Milk 34 Margarine 34 Bakehouses 34 Sale of Fish 34 Fried Fish Shops 34 Market Streets and Exposure of Food Generally 35 Street Trading 35 Ice Cream 36 Meat Regulations 36 Places where Food is Prepared for Sale 36 Inspection of Restaurant Kitchens 37 Unsound Food 37 Preservatives in Food Regulations 38 Food and Drugs (Adulteration) Act, 1928 38 Articles Analysed 38 Borough Analyst, Notes by 40 The Merchandise Marks Act, 1926 43 London County Council (General Powers) Act, 1932 43 Registration of Food Premises 43 Notification of Food Poisoning 43 Slaughter of Animals Act, 1933 43 A 2 4 Page Prevalence of and Control over Infectious Diseases Infectious Diseases Generally 44 Smallpox 45 Vaccination 45 Diphtheria 46 Diphtheria in Hospitals 47 Diphtheria Contacts 48 Schick Test and Immunisation against; Diphtheria 48 Diphtheria in Children Treated with Immunising Injections 51 Immunisation of Nursing Staff at London Homoeopathic Hospital 52 Immunisation of School Children 53 Soarlet Fever 53 Acute Rheumatism in Children 53 Holidays for Rheumatic Children 56 Typhoid and Paratyphoid Fevers 56 Typhus Fever 56 Cerebro-Spinal Fever 56 Bacillary Dysentry 56 Malaria 57 Encephalitis Lethargies 57 Acute Poliomyelitis and Acute Polioencephalitis 57 Pneumonia 57 Influenza 58 Anthrax 58 Chickenpox 58 Mumps 58 Bacteriological Work 58 Disinfections 58 Cleansing of Persons Act 59 Shelter during Disinfection 59 Extermination of Vermin 59 Cancer 59 Tuberculosis 60 Summary of Notifications and Deaths 60 Public Health (Tuberculosis) Regulations, 1930 61 Supplemental Return 61 Notification Register 62 Tuberculosis Notifications 62 Sleeping Conditions 62 Classification of Homes 63 Non-attendance at Tuberculosis Dispensary 63 Institutional Treatment 64 Visits to Home 64 Contacts 64 Tuberculosis Dispensary Return 65 Deaths of Tuberculous Persons 67 Tuberculosis Care Committee 67 Public Health (Prevention of Tuberculosis) Regulations, 1925 69 Home Nursing 69 Dental Clinic 69 General Dental Clinic 69 Maternity and Child Welfare Notification of Births 70 Number of Births 70 Births in Crowded Homes 70 Home Visiting 71 Work at Centres 71 10, John Street 71 Short's Gardens 72 Ante-natal Hygiene 72 Confinements in Institutions in relation to Housing Conditions 72 Baths 73 Ante-natal Centres 73 Post-natal Consultations 74 Instruction in Mothercraft and Hygiene 74 Maternal and Infant Consultations 74 Breast Massage 75 Pre-School Children 75 5 Page Foundling Site Day Nursery 76 School Entrants 76 Stillbirths 76 Illegitimate Births 77 Dental Treatment 77 Supply of Milk and Food for Mothers and Infants 77 Home Help 78 Convalescent Home Treatment 78 Saffron Hill Maternity and Child Welfare Centre 78 Deaths of Infants under One year 79 Infectious Diseases among Mothers and Children 80 Fuerperal Fever and Pyrexia 80 Ophthalmia Neonatorum 81 Midwives Acts, 1902 and 1918 82 Whooping Cough 82 Measles 82 Measles Control in Schools 82 German Measles 83 Diarrhoea and Enteritis under 2 years 83 Nursing Arrangements 83 Minor Ailments Clinic 83 Medical Inspection and Treatment of School Children 84 Infant Life Protection 86 Birth Control 86 Health and Baby Week 86 Sanitary Administration Mortuary 87 Inquests 88 Removal of Aged Persons 88 Rent and Mortgage Interest, Restriction Acts, 1920-1933 88 Nuisance from Pigeons 89 Old Buildings—Demolition of 89 Propaganda 89 APPENDIX. Table I. Vital Statistics, 1935, and ten previous years 91 Table II. Causes of and Ages at Death, 1935 92 Table III. Infectious Diseases Notified during 1935 93 Table IV. Information required by L.C.C. 94 Table V. Factories, Workshops, &c. (1) Inspections 95 (2) Defects found 9.5 (3) Home Work 96 (4) Registered Workshops 97 (5) Other Matters 97 Legal Proceedings 98 Ambulance Service (see inside of back cover). List of Notifiable Diseases (see back of cover). 6 PUBLIC HEALTH COMMITTEE. 1935-36. 1934-35. Chairman— Chairman- Councillor John W. Roberts. Councillor John W. Roberts. Vice-Chairman- Vice-Chairman- Councillor William R. Cons. Councillor William R. Cons. Ex-Officio— His Worship The Mayor, His Worship The Mayor, Councillor Horace W. Langdon, J.P., F.S.I. Councill Wilfred E. Mullen, J.P. The Deputy Mayor, Councillor Wilfred E. Mullen. The Deputy Mayor, Alderman Albert A. Mussett. Alderman Albert A. Mussett. Alderman Ernest Hamlin, M.B.E. ,, Ernest Hamlin, M.B.E. Councillor Thomas Aubertin, M.A. Councillor Thomas Aubertin, M.A. ,, John H. Boraston, C.B. „ John H. Boraston, C.B. ,, Mrs. Edith Elliott. „ Mrs. Edith Elliott. ,, Mrs. Charlotte Harris. ,, Mrs. Charlotte Harris. ,, Edgar L. Pilditch, B.A. ,, William H. M. Smeaton, F.R.San.I. ,, Robert H. R. Tasker. „ Robert H. R. Tasker. ,, John O. M. Turnbull. „ John O. M. Turnbull. „ T. Magnus Wechsler, LL.B. „ William R. Wheatley. „ William R. Wheatley. HOUSING OF THE WORKING CLASSES COMMITTEE. 1935-36. 1934-35. Chairman— Chairman— Alderman Robert P. Bristow. Alderman Robert P. Bristow. Vice-Chairman— Vice-Chairman— Councillor Robert H. R. Tasker. Councillor Robert H. R. Tasker. Ex-Officio— Ex-Officio— His Worship The Mayor, His Worship The Mayor, Councillor Horace W. Langdon, J. P., F.S.I. Councillor Wilfred E. Mullen, J. P. The Deputy Mayor, Councillor Wilfred E. Mullen. The Deputy Mayor, Alderman Albert A. Mussett Alderman Albert A. Mussett. Councillor George J. Bailey. Councillor George J. Bailey. „ Alan P. Good, B.A. „ Alcwyn Harries. „ Alcwyn Harries. „ Roland H. Haxell. „ Roland H. Haxell. „ Miss Florence M. Herbert. „ Miss Florence M. Herbert. „ James F. Howes, A.R.I.B.A. „ James F. Howes, A.R.I.B.A. „ George D. Pooley. „ Harry Myers. „ Alfred R. Taylour, M.A. „ George D. Pooley. „ John O. M. Turnbull. ,, John O. M. Turnbull. „ T. Magnus Wechsler, LL.B. ,, T. Magnus Wechsler, LL.B. 7 MATERNITY AND CHILD WELFARE COMMITTEE. 1935-36. 1934-35. Chairman— Chairman— Councillor Mrs. Edith Elliott. Councillor Mrs. Edith Elliott. Vice-Chairman— Vice-Chairman— Councillor Thomas Aubertin, M.A. Councillor Thomas Aubertin, M.A. Ex-Officio— Ex-Officio— His Worship The Mayor, His Worship The Mayor, Councillor Horace W. Langdon, J.P., F.s.I. Councillor Wilfred E. Mullen, J.P. The Deputy Mayor, Councillor Wilfred E. The Deputy Mayor, Alderman Albert A. Mussett. Mullen. Alderman Robert P. Bristow. Councillor Alcwyn Harries. ,, Albert A. Mussett. ,, Mrs. Charlotto Harris. Councillor Mrs. Harris. ,, Miss Florence M. Herbert. ,, Harry Myers. ,, Thomas LI. Humberstone, B.Sc. ,, George D. Pooley. ,, Horace W. Langdon, F.S.I. ,, John W. Roberts. ,, George D. Pooley. ,, H. H. Raymond Ward. „ John W. Roberts. „ William R. Wheatley. „ William R. Wheatley. The Mayoress (Mrs. Horace W. Langdon). Mrs. Wilfred E. Mullen (Mayoress). Miss E. Emly. Miss E. Emly. Mrs. Percy Hill. Mrs. Percy Hill. „ W. E. Mullen. Mrs. Albert A. Mussett. ,, John W. Roberts. ,, John W. Roberts. TUBERCULOSIS CARE COMMITTEE. Holborn Borough Council Councillor J. W. Roberts. Medical Officer of Health (Dr. J. A. Struthers). Tuberculosis Dispensary Tuberculosis Officer (Dr. A. J. Morland (from December, 1935). Councillor William R. Wheatley. London County Council Dr. Margaret Hogarth. Miss M. Ball. Public Assistance Committee Mr. W. J. Marchant (to Octobor, 1935). Mrs. F. M. Keen (from December, 1935). Local Association of Children's School Care Miss K. J. Swayne. Committees. Juvenile Advisory Committee Mrs. J. L. Dicker. Insurance Committee for the County of Mr. H. A. Teakle. London. Almoners of hospitals Miss J. G. Salmon. Miss Voelcker (Vice-Chairman). British Legion and United Services Fund Benevolent Committee Mr. R. F. Freeman. British Red Cross Emergency Help Fund Major-General Patrick B. Sangster, C.B., C.M.G., D.S.O. Charity Organisation Society Miss E. F. Bolton. Invalid Children's Aid Association Miss Butler. Metropolitan District Nursing Association Miss E. Emly. National Council of Social Service Sir Ewan R. Logan, M.A. Northern London War Pensions Committee Vacancy. Other social workers (co-opted) Mrs. E. C. Bedford. Mrs. Percy Hill (Chairman). Miss O. Lazarus. Miss H. M. Malhieson (Honorary Secretary). 8 STAFF. The following was the Staff during 1935. Medical Officer of Health—J. A. Struthets, M.D., BCh., M.R.C.P., D.P.H. Medical Officers of Maternity Centres— 10, John Street—Richenda Gillett, M.D.Brux., L.S.A. Winefride M. Gibson, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Short's Gardens—J. A. Struthers, M.D., B.Ch., M.R.C.P., D.P.H. (to October, 1935). Olive Lloyd, M.R.C.S., L.R.C.P. (from October, 1935). Consultant Medical Officer—Puerperal Pyrexia and Puerperal Fever Regulations (1926-1928) J. D. Barris, M.B., F.R.C.P., F.R.C.S., 10, Cornwall Terrace, Regents Park, N.W. 1. Medical Officer of Tuberculosis Dispensary— J. A. Struthers, M.D., B.Ch., M.R.C.P., D.P.H. (to October, 1935). Andrew Morland, M.D., M.R.C.P., M.R.C.S. (from October, 1935). Medical Officer—Diphtheria Immunisation—E. Goodwin Rawlinson, M.D., L.R.C.P., D.P.H Public Analyst—James Kear Colwell, F.I.C. Sanitary Inspectors—Albert Bennett. George F. Clark. Samuel Larard, M.R.San.I. S. G. Fisher (from December, 1935). Sanitary Inspector and Health Visitor—Ethel Jane Charlesworth, C.M.B. Health Visitor—Muriel G. Stockwell, C.M.B. Tuberculosis Health Visitor—M. Watson. Chief Clerk and Committee Clerk—Edwin Kent. Assistant Clerks—Frank Fitch. Arthur Long. Albert R. Shott. Lena M. Shimmin (to June, 1935). Knorette Hand (from June, 1935). Dentist—J. C. Sinclair, L.D.S. (British Dental Hospital). Anaesthetist— Maurice Hudson, M.B., B.S. (Lond.). Nurses—The Metropolitan District Nursing Association. Mortuary Keeper and Superintendent of Cleansing Station—Bertie Downing. Superintendent of Women's Cleansing Station—Nellie M. Downing. Caretaker of Maternity Centre—Elizabeth Alderton. Home Help—Panel of Home Helps. Disinfector—Henry Emms. Assistant Disinfector—E. E. Denny. Deputy Disinfector—James Sullivan. Addresses of other Public Officials more or less connected with Public Health Work. Public Vaccinators. Holborn District, Eastern part of Borough (East of Southampton Row)— Dr. F. Robinson, 43, Rosebery Avenue, E.C. 1. Telephone No. Terminus 4624. Hours 11 a.m. to 12 noon, and 6.30 to 8 p.m. (except Thursday evenings). St. Giles and Bloomsbury District, Western part of Borough (West of Southampton Row)— Dr. George D. Fairley, 15a, Gower Street, W.C. 1. Telephone No. Museum 0691. Hours 9 to 10 a.m. and 6 to 7 p.m. (except Wednesdays). Vaccination Officer—Mr. Percy E. Capps, Town Hall, 197, High Holborn, W.C. 1. Registrar of Births and Deaths—Mr. W. J. Clark, 14, 16 and 18, Bloomsbury Street. Certifying Surgeon (Factory & Workshop Acts)—Dr. W. D. Brunton, 72, Euston Square, N.W.I. If. M. Inspector of Factories—N. W. London District, 68-70, Baker Street, W. 1. District Surveyor—Mr. F. P. Scott, 5-11, Theobald's Road. H.M. Coroner—S. Ingleby Oddie, Esq. Coroner's Officer—Mr. James Stabb, 46. Baker Street, Lloyd Square, W.C. 1. Honorary Secretary, Tuberculosis Care Committee— Miss H. M. Mathieson, Town Hall, High Holborn. 9 STATISTICS AND SOCIAL CONDITIONS. Statistical Summary, 1935. Area of Borough in acres 405.1 Resident population —estimated to middle of 1935 (as supplied by the Registrar-General) for birth and death rates 35,400 Number of inhabited houses (1931) 6,462 Number of private families or separate occupiers (1931) 9,355 Rateable value 1st October, 1935 £1,752,351 Rate of 1d. in the £ estimated to yield £6,708 Total M. F. Live Births Legitimate 229 125 1041 Birth Rate per 1,000 of the estimated resident population 7.65 Illegitimate 42 20 22 Stillbirths 12 — — Rate per 1,000 total (live and still) births 42.4 Deaths 420 255 165 Death Rate per 1,000 of the estimated resident population 11.7 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List):— Deaths. Rate per 1,000 total (live and still) births. No. 29 Puerperal sepsis 1 3.53 No. 30 Other Puerperal causes — Total 1 3.53 Death Rate of Infants under one year of age:— All infants per 1,000 live births 88 Legitimate infants per 1,000 legitimate live births 78 Illegitimate infants per 1,000 illegitimate live births 143 Deaths from measles (all ages) 0 ,, „ whooping cough (all ages) 2 ,, „ diarrhoea (under 2 years of age) 4 Tuberculosis, all causes, death-rate per 100,000 84.7 Excess of registered births over deaths — Excess of registered deaths over births 149 Vital Statistics, 1935. England and Wales, London and Holborn. Annual Rates per 1,000 living. Deaths under 1 year to 1,000 Births. Births. Deaths. England and Wales 14.7 11.7 57 London 13.3 11.4 58 Holborn 7.65 12.7 10 Registered Births. The total number of births registered as occurring in the Borough was 134 (76 males and 58 females). Of these, 123 were legitimate and 11 illegitimate. Corrected Births and Birth-Rate. I received from the Registrar-General information of the births in outlying institutions in London of 110 legitimate infants and 34 illegitimate infants whose mothers were residents of the Borough. Seven of the births occurring in the Borough were infants of mothers who were not resident in the Borough. The corrected number of births is therefore 271, and the corrected birth-rate 7.65. The following is the corrected number of births and the corrected birth-rates for the year 1935:— Year. Total Births. Legitimate Births. Illegitimate Births. No. Rate per 1,000 of Population. No. Rate per 1,000 of population. Proportion per 1,000 total Registered Births. No. Rate per 1,000 of population. Proportion per 1,000 total Registered Births. 1935 271 7.65 229 6.47 845 42 1.19 155 In London the corrected birth rate in 1934 was 13. 2 per 1,000 in comparison with 13.3 for 1935. Mortality. The total number of deaths registered as occurring in the Borough was 668, of which 372 were males and 296 females. Of these deaths the following occurred in Public Institutions, etc., within the area of the Borough:— Institution. Residents. Non-Residents. French Hospital 4 42 Hospital for Sick Children 5 203 Italian Hospital 3 23 London Homœopathic Hospital 7 81 National Hospital 1 127 Royal Westminster Ophthalmic Hospital — 1 St. Paul's Hospital 1 28 Other places — 21 Total 21 526 There were 278 deaths of civil "residents" in various Workhouses, Infirmaries, Asylums, Hospitals, etc., outside the Borough, 40 of whom were, removed from Common Lodging Houses in the Borough. ll The deaths are further corrected by the Registrar-General by the inclusion of all deaths registered in the calendar year as distinct from the registration year of 52 weeks. This correction, together with deaths transferred from extra Metropolitan Institutions, accounts for the variation in the number of deaths given in the four quarterly reports of the Registrar-General and in his Annual Report. The final correction supplied by the Registrar-General for 1935 gives the total deaths for the Borough as 420. Corrected Deaths and Death-Rates, 1935, compared with 1934. Year. Total Deaths at all ages registered in District. Deaths in Public Institutions in District Deaths of nonresidents of Borough registered in District. Deaths of residents registered beyond the District. Net Deaths at all ages. Death Rate for Borough (crude). Death Rate for Borough. (adjusted). Death Rate for London 1934 699 581 552 293 440 † 12.2 13.05 11.9 1935 668 547 526 278 420 † 11.9 12.7 11.4 For details of causes of and ages at death, (see Table II, page 92). † There rates are calculated on the Registrar-General's estimated populations at the middle of the year 1934 and 1935 respectively. Infantile Mortality. The number of deaths of children under one year of age, and the number of deaths of children under one year of age per 1,000 corrected births, were the following:— Year. Deaths under 1 year of age. Deaths of legitimate infants under 1 year per 1000 corrected legitimate Births. Deaths of illegitimate infants under 1 year per 1000 corrected illegitimate Births. Deaths, all infants under 1 year per 1000 corrected Births. London. Deaths under 1 year per 1000 Births. 1934 22 66 114 71 67 1935 24 78 143 88 58 Death-rate per 1,000 corrected births in 1934 and in ten preceding years. 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 Avge. 1925-34 1935 Holborn Borough 63 90 38 57 74 89 74 72 70 71 69.8 88 London 67 64 59 67 70 59 65 67 59 67 64.4 58 See also Table, page 91. The figures on which the rates given in the Registrar-General's Quarterly Reports are based are necessarily only partly corrected; the final correction including the transference of births in institutions to the residential area of the parents is made before the publication of the Registrar-General's Annual Report. 12 Deaths in Public Institutions Of the total number of 420 deaths, 299 died in hospitals and public institutions either within or without the Borough. General Provision of Health Services in the Borough. Public Health Officers. The following changes in the staff during the year 1935 are recorded:— Medical Officer of Health—Dr. J. A. Struthers, who had been Acting Medical Officer of Health since the death of Dr. C. W. Hutt, took up his duties as Medical Officer of Health on the 17th October, 1935. Medical Officer—Maternity and Child Welfare.—Dr. Olive Lloyd was appointed Medical Officer of the Short's Gardens Maternity and Child Welfare Centre, to fill the vacancy caused by the retirement of Dr. J. A. Struthers on his appointment as Medical Officer of Health. Tuberculosis Officer—Dr. Andrew Morland, who was appointed Tuberculosis Officer in succession to Dr. J. A. Struthers, commenced his duties in December, 1935. Sanitary Inspector.—In the Annual Report for 1934 reference was made to the proposed appointment of an additional Sanitary Inspector. In pursuance of the decision of the Council in this matter, Mr. S. G. Fisher was appointed to the office of Sanitary Inspector, taking up his duties from the 1st December, 1935 (see also page 8). Nursing in the Home. (a) General.—Nursing service for the sick poor is supplied by the Metropolitan District Nursing Association, 31, Bedford Place, W.C. 1. (b) Infectious Diseases.—By arrangements made by the Borough Council with the Nursing Association, nurses are available for cases of:— Summer Diarrhœa (in children under 2 years of age). Measles with severe complications. Whooping Cough with severe complications. Lobar Pneumonia. Influenzal Pneumonia. Ophthalmia Neonatorum. Encephalitis Lethargica. Pemphigus Neonatorum. Puerperal Fever. Puerperal Pyrexia. Tuberculosis. (c) Maternity.—By arrangement with the Metropolitan District Nursing Association, skilled maternity nursing is available for necessitous maternity cases subject to prior approval of the Maternity and Child Welfare Committee or the Medical Officer of Health, also for complications after confinement, including deficient lactation. Contributions towards the service are required in connection with maternity nursing and the nursing of puerperal fever and puerperal pyrexia, the amount being assessed according to ability to pay. Home Helps. Home Helps are available for service in homes during confinements—contributions towards the cost are required in accordance with ability to pay. Midwives. The Borough Council does not employ or subsidise midwives. National Health Insurance. No necessity has arisen for any special co-operation. 13 Laboratory Facilities. Bacteriological examinations (sputum, swabs, etc.), carried out at the laboratory of the Royal Institute of Public Health, Queen Square. Chemical analysis, milk and foodstuffs, carried out by the Borough Analyst at his laboratory, Finsbury Town Hall, Rosebery Avenue, E.C. 1. Legislation in Force. Local Acts.—The London County Council (General Powers) Acts, 1893-1935. Special Orders.—The Holborn (Acute Rheumatism) Regulations, 1932, requiring the notification of acute rheumatism in children up to the age of 16 years. Transfer of Powers (London) Order, 1933—transferring certain duties from the London County Council to the Borough Council in respect of (a) Building Lines; (b) Disused Burial Grounds; (c) Seamen's Lodging Houses; (d) Thames and other Embankments; (e) Common Lodgingi Houses; (f) Cow houses and places for keeping cows; (g) Infant Life Protection; (h) Offensive Trades; (i) Slaughter houses and Knackers' yards. Merchandise Marks Act, 1926.—Orders relating to imported Fresh Apples; Currants, Sultanas and Raisins; Eggs (Hen or Duck) in shell; Dried Eggs; Oat products; Raw Tomatoes; Bacon and Ham; Dead Poultry; Meat; Frozen or Chilled Salmon; Butter; Honey. New Legislation. (A) Acts of Parliament— (1) Housing Act, 1935. (2) London County Council (General Powers) Act, 1935. (b) Orders and Regulations— (1) Sale of Food (Revocation) Order, 1935. (2) Anthrax Order, 1935. (3) Public Health (Meat) Amendment Regulations, 1935. (4) Pharmacy and Poisons Act, 1933 (Date of Commencement Order, 1935. (5) Poisons List (Confirmation) Order, 1935. (6) Poisons Rules, 1935. (7) Merchandise Marks Act Orders (pre packed imported salt). (8) Sanitary Officers (London) Regulations, 1935. (9) Orders under Agricultural Produce (Grading and Marking) Acts relating to various foods. (10) Housing Acts (Overcrowding and Miscellaneous Forms) Provisional Regulations, 1935. By-Laws and Regulations in force, relating to Public Health, made by London County Council. Subject. Act under which made. Date. Ash pits and receptacles for flung Public Health (London) Act, 1891 28th June, 1893 ditto ditto 11th July, 1913 Bone boiler, manure manufacture or tallow melter ditto 25th November, 1907 Common lodging houses L.C.C. (General Powers) Act, 1902 14th August, 1903 Conveyance of dead horses ditto 1903 21st February, 1905 Cleansing and disinfection of lairs and vehicles for conveyance of animals Foot and Mouth Diseases Order, 1928 1st April, 1931 Drainage Metropolis Local Management Act, 1855 28th July, 1934 Demolition of buildings L.C.C. (General Powers) Act, 1927 4th November, 1929 Dresser of fish skins Public Health (London) Act, 1891 28th November, 1907 Dresser of fur skins ditto ditto Fat melter ditto ditto Fishmonger ditto ditto 14 By-Laws and Regulations in force, relating to Public Health, made by London County Council, continued. Subject. Act under which made. Date. Fish curer L.c.c. (General Powers) Act, 1908 28th February, 1914 Fried fish, vendors of ditto March, 1914 Gut scraper and catgut maker Public Health (London) Act, 1891 28th November, 1907 Glue and size manufacturer ditto ditto Hairdressers' establishments in which massage treatment is given L.C.C. (General Powers) Act, 1915 15th June, 1921 Knacker, business of Public Health (London) Act, 1891 25th November, 1907 Massage establishments L.C.C. (General Powers) Act, 1920 28th July, 1921 Nursing homes Nursing Homes Registration Act, 1927 1st March, 1929 Offensive matter, removal of Public Health (London) Act, 1891 26th November, 1901 Rag and bone dealers L.C.C. (General Powers) Act, 1908 18th September, 1923 ditto ditto 20th June, 1928 Receptacles for dung Public Health (London) Act, 1891 3rd January, 1905 Seamen's lodging houses Merchant Shipping Act, 1894 1st April, 1917 Spitting in public places Municipal Corporation Act, 1882, and Local Government Act, 1888 12th May, 1903 Soap boiler Public Health (London) Act, 1891 25th November, 1907 Slaughter of poultry ditto ditto ditto ditto 31st July, 1935 Slaughter houses Slaughter houses, etc. (Metropolis) Act, 1887, and Local Government Act. 1888 27th October, 1891 Smoke emission Public Health (Smoke Abatement) Act, 1926 19th May, 1931 Tripe boiler Public Health (London) Act, 1891 25th November, 1907 Tenement houses Public Health (London) Act, 1891, and Housing Act, 1925 5th March, 1926 ditto ditto 8th June, 1931 Water closets, urinals, etc. Public Health (London) Act, 1891, and L.C.C. (General Powers) Act, 1928 21st August, 1930 Waste paper and refuse in streets Municipal Corporations Act, 1882, and Local Government Act, 1888 29th May, 1906 Made by the Holborn Borough Council. Subject. Act under which made. Date Prevention of Nuisances, snow, ice, salt, dust, rubbish, offal, carrion, fish, filth or other matter or thing in any street Public Health (London) Act, 1891 19th August, 1923 Offensive matter from manufactory, ditto ditto Keeping of animals ditto ditto Paving of yards ditto ditto Decent conduct of persons using public lavitories ditto 15th March, 1897 Nuisance from wireless loud speakers or gramophones Municipal Corporation Act, 1882, and Local Government Act, 1888, and London Government Act, 1889 7th November, 1930 Suppression of street cries ditto 12th October, 1900 Cleansing of cisterns Public Health (London) Act, 1891 19th August, 1893 Nuisances by dogs (excrement on public way) Municipal Corporation Act, 1882, and Local Goverment Act, 1888, April, 1926 Regulation of Public Baths and Washhouses Baths and Washhouses Act, 1846 May, 1877 Street trading, regulations of L.C.C. (General Powers Act, 1927) Feb. 1928 Underground rooms Housing Town Planning Act, 1925 February, 1936 15 Hospitals. Hospitals provided or subsidised by the Local Authority or by the London County Council. Fever and Smallpox.—Hospitals for patients suffering from these diseases are provided by the London County Council—one of the hospitals of the Council (St. Margaret's) is also available for cases of Marasmus and Ophthalmia Neonatorum. Tuberculosis.—Residential institutional treatment for tuberculosis is provided by the London County Council. The Borough Council's Tuberculosis Dispensary is situated at, and linked up with, the University College Hospital. Maternity.—The Borough Council has arranged for the reservation of beds for maternity cases at the University College Hospital. Contributions towards cost of maternity service are paid by the Council to: University College Hospital; City of London Maternity Hospital; Royal Free Hospital; and other hospitals providing maternity service for Holborn mothers. Hospitals Situated in the Borough of Holborn—Not Subsidised by the Local Authority. Name. Situation. Purpose. Number of Beds. Management. Remarks. French Hospital and Dispensary Shaftesbury Avenue General—for all poor who speak French 70 Voluntary body Hospital for Sick Children Great Ormond Street A general hospital for the treatment of sick children from birth up to 12 years of age 256 Voluntary body Italian Hospital Queen Square General—for people of Italian ex. traction especially, but all nationalities treated 53 Voluntary body National Hospital Queen Square Nervous system, paralysis and epilepsy 186 Voluntary body Royal Westminster Ophthalmic Hospital Broad Street Eye 88 Voluntary body London Homœpathic Hospital Great Ormond Street & Queen Square General 200 Voluntary body St. Paul's Hospital Endell Street For diseases (including cancer) of the genitourinary organs and skin 33 Voluntary body N-B —The use of the above hospitals extends to residents outside the Holborn Borough area. 16 Maternity and Nursing Homes. The Local Supervising Authority in London under the Nursing Homes Registration Act, 1927, is the London County Council. Maternal Mortality. Maternal deaths are investigated by the Medical Officer of Health; cases of puerperal fever and puerperal pyrexia by the Health Visitors. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children. There are no institutions for unmarried mothers, illegitimate children or homeless children in the Borough, but St. Faith's Home, Myddleton Square, receives such mothers from the Holborn area. Institutions for the Care of Mental Defectives. There is no institution in the Borough for the care of mental defectives. Ambulance Facilities (see inside of back cover). For Infectious Cases—Frovided by the London County Council ('Phone: Waterloo 3311). For Non-Infectious Cases—The Ambulances of the London County Council. (Minimum fee 10/-.) For Accidents—The London County Council and the St. John Ambulance Association. For Maternity—The London County Council Ambulances ('Phone Waterloo 3311). Clinics and Treatment Centres. Ante-natal and Post-natal Clinic. 10, John Street (Municipal) Tuesday at 2 p.m. Short's Gardens (Municipal) Thursday 2 p.m. Maternity and Child Welfare. 10, John Street (Municipal) {Tuesday Wednesday Thursday Friday} at 2 p.m. St. Giles' Buildings (Municipal) }Thursday at 2 p.m. (Short's Gardens) Saffron Hill, Onslow Street {Thursday Friday} 2.4 p.m. 6.7.30 p.m. Pre-School Child. 10, John Street (Municipal) Monday at 2 p.m. Minor Ailments Clinic. 10, John Street (Municipal) {Tuesday Friday} at 2 p.m. Diphtheria Schick Test and Immunisation. 10, John Street (Municipal) Wednesday at 2.30 p.m. General. Bloomsbury Dispensary, 12, Bloomsbury Street Daily. Acute Rheumatism (Children), up to age of 12 years. Hospital for Sick Children, Great Ormond Street Daily. Dental. 10, John Street, for expectant and nursing mothers and children up to 5 years (Municipal) Thursday at 2 p.m. 10, John Street, General and for Tuberculous Patients Tuesday at 6.30 p.m. 17 School Clinics. The following treatment Centres are provided under the L.C.C. Schemes:— (1) Finsbury Centre, Spencer Street, Goswell Road. (2) Moorfields Ophthalmic Hospital, City Road. (3) Soho Centre, Gerrard Street. (4) Lancing Street Centre, Lancing Street, N.W. 1. (5) Cleansing Station (Scabies) Children's Baths, Central Street, E.C. 1. Centres are also provided at the following Hospitals and Dispensaries:— (1) St. Bartholomew's Hospital. (2) Bloomsbury Dispensary. (3) Central London Ophthalmic Hospital. (4) Central London Throat and Ear Hospital. (5) Dental Hospital. (6) Homœpathic Hospital. (7) Hospital for Sick Children. (8) Italian Hospital. (9) Metropolitan Ear, Nose and Throat Hospital. (10) Middlesex Hospital. (11) Royal Free Hospital. (12) Tuberculosis Dispensary, University College Hospital. (13) University College Hospital. Day Nurseries.—Established and controlled privately:— Kingsway Creche, Kingsway Hall, Kingsway. Field Lane Institution Creche, Vine Street, Clerkenwell Road. St. Alban's Day Nursery, Greville Street. Tuberculosis Dispensary. At University College Hospital (entrance in Huntley Street). Venereal Diseases.—Treatment clinics are arranged by the London County Council. Those in the Borough are: St. Paul's Endell Street, daily 8 a.m. to 10 p.m. Hospital for Sick Children (for children only), Great Ormond Street, 9-10 a.m. daily and 2-4 p.m., except Wednesday and Saturday. Cleansing Station for Verminous Persons. Goldsmith Street, Drury Lane. Births and Deaths—Registration. Oakley House, 14, Bloomsbury Street. Daily, 11 a.m. to 12 noon. Monday and Friday, 2 to 3 p.m. Public Vaccinators. Eastern part of Borough—East of Southampton Row. Dr. Robinson, 43, Rosebery Avenue. 11 a.m. to 12 noon and 6.30 to 8 p.m., except Thursday evening. Western part of Borough—West of Southampton Row. Dr. G. D. Fairley, 15a, Gower Street. 9 to 10 a.m. and 6 to 7 p.m., except Wednesdays. Ambulance Service. Particulars of the ambulance services available in the Borough are given on the inside page of the back cover. SANITARY CIRCUMSTANCES OF THE BOROUGH. Removal of Offal. No breach of the by-laws made by the London County Council respecting the removal of offal was reported during the year. Removal of Manure. The removal of manure from the various mews in the Borough was generally satisfactorily carried out during the year. B 18 Sanitary Inspection of the District, including Premises and Occupations which can be controlled by By-Laws and Regulations. In addition to my inspections, the Sanitary Inspectors made 19,800 various inspections and visits as set out in the following table. One inspection frequently covers a number of different sanitary matters. Sanitary Inspectors' and Health Visitors' Work Year, 1935. Mr. Bennett Mr. Clark Mr. Fisher Mr. Larard Miss Charlesworth Miss Stockwell Total Complaints received 44 46 ... 24 2 ... 116 Do. found to be justified 44 46 ... 24 2 ... 116 Inspection of Houses— Dwelling-houses 132 304 3 114 1 ... 554 Houses let in lodgings 284 293 ... 139 23 ... 739 Common lodging-houses 8 9 ... 11 5 ... 33 Drains tested by chemical 1 ... ... ... ... ... 1 Do. smoke 17 15 ... 27 ... ... 59 Do. water 40 42 ... 60 ... ... 132 Factories— Bakehouses 4 7 1 2 ... ... 14 Food preparation 2 ... ... 92 ... ... 94 Other 7 24 2 319 ... ... 352 Laundties ... ... • •• ... ... ... ... Workshops and Workplaces— Food premises: Dairies and Milkshops 62 62 13 80 ... ... 207 Ice Cream, Manufacture ... 6 ... 30 ... ... 36 Do. Storage or Sale ... 10 ... 5 ... ... 15 Slaughter-houses ... 10 1 ... ... ... 11 Hotels and Restaurants 137 73 102 143 ... ... 455 Butchers 264 42 8 281 ... ... 595 Bakehouses 6 8 ... 4 ... ... 11 Fish shops 6 5 ... 8 ... ... 19 Fried Fish shops 201 39 2 30 ... ... 272 Market Streets 289 112 28 673 ... ... 1102 Licensed Premises 3 1 ... 5 ... ... 9 Other food shops 145 21 10 104 ... ... 280 Merchandise Marks Act, 1926 173 67 4 71 ... ... 315 Other workshops 24 60 ... 255 8 ... 347 Other workplaces 62 93 1 134 2 ... 292 Outworkers' Registers 14 41 ... 25 ... ... 80 Do. Rooms ... ... ... ... ... ... ... Laundries ... ... ... ... ... ... ... Stables and Stable yards 1 88 ... ... ... ... 89 Rag and Bone shops ... 2 ... ... ... ... 2 Offices 7 1 ... 16 ... ... 23 Shops (Shops Act) 113 113 ... 149 2 ... 377 Miscellaneous— Black smoke ... 17 ... 65 ... ... 82 Rats and Mice (Destruction) Act 128 226 ... 64 ... ... 418 Food and Drugs Act—Sampling 204 203 31 199 ... ... 637 Demolition of buildings 6 13 ... 8 ... ... 22 Other Inspections 1 5 ... ... 2 ... 8 Keeping of Animals 2 2 ... ... ... ... 4 Periodical Inspections: Including W.C. and yards, dust-bins, especially houses let in lodgings, and other similar dwellings 981 1,648 ... 2,391 ... ... 5,030 Inspections carried forward 3,314 3,662 206 5,488 43 ... 12,713 19  Mr. Bennett Mr. Clark Mr. Fisher Mr. Larard Miss Charlesworth Miss Stockwell Total Brought forward 3,314 3,662 206 5,488 43 ... 12,713 Re-Inspections— Houses 1,180 944 ... 428 8 ... 2,560 Factories 101 5 ... 16 ... ... 122 Workshops 5 2 ... 45 ... ... 52 Workplaces 328 392 ... 302 ... ... 1,022 Restaurants 6 13 1 15 ... ... 35 Licensed premises ... 4 ... 3 ... ... 7 Offices ... ... ... 1 ... ... 1 Miscellaneous ... ... ... ... 31 74 105 Visits re Infectious Diseases 56 93 ... 83 34 85 351 Scabies ... ... ... ... ... 1 1 Verminous persons ... ... ... ... ... ... ... Other Visits— Police Courts 2 1 ... 1 ... ... 4 Various 119 286 7 141 7 4 564 Maternity— Visits: Children under 1 year ... ... ... ... 106 158 264 Do. 1 to 2 years ... ... ... ... 11 16 27 Do. 2 to 3 ,, ... ... ... ... 6 2 8 Do. 3 to 4 ,, ... ... ... ... 3 6 9 Do. 4 to 5 „ ... ... ... ... 3 9 12 Expectant Mothers ... ... ••• ... 100 70 170 Infant Life Protection ... ... ... ... 7 20 27 Re-visits: ... ... ... ... ... ... ... Children under 1 year ... ... ... ... 121 260 381 Do. 1 to 2 years ... ... ... ... 56 124 180 Do. 2 to 3 ,, ... ... ... ... 60 103 163 Do. 3 to 4 „ ... ... ... ... 41 73 114 Do. 4 to 5 ,, ... ... ... ... 35 33 68 Expectant Mothers. ... ... ... ... 84 161 245 Infant Life Protection ... ... ... ... 6 16 22 Other Maternity Visits ... ... ... ... 71 122 193 Attendances at Maternity Centres ... ... ... ... 205 175 380 Total 5,111 5,402 214 6,523 1,038 1,512 19,800 Notices Served. The total number of notices served for nuisances found in dwelling houses and factories, workshops and workplaces, and premises subject to various By-laws, including notices requiring annual cleansing of houses let in lodgings, was 1,097, viz.:— Public Health (London) Act, 1891- Intimation Notices 425 Statutory Notices 45 By-laws— Houses let in lodgings 595 London County Council (General Powers) Acts— Verminous rooms 28 Rats and Mice (Destruction) Act, 1919 4 1,097 b 2 20 The following table shows the work done to abate nuisances for which intimation notices were served:— Water Supply— Houses. Factories, Workshops and Workplaces Provided 2 4 Cisterns cleansed, repaired etc. 16 9 Waterclosete— Cleansed 13 7 Water supplied, flushing cistern repaired, etc. 6 6 Repaired, new pans, etc. 45 13 Ventilation improved 3 12 Separate accommodation for sexes provided — 4 Position or construction improved 2 3 Direct communication with workrooms remedied — 3 Accommodation provided 1 7 Unstopped 21 4 Urinals, repaired, cleansed, etc. — 1 Soil Pipes— Repaired, renewed and ventilated 8 3 Rainwater Pipes— Repaired or renewed 19 3 Drains— Repaired 27 9 Unstopped, cleansed, etc. 19 9 Sinks, etc.— Waste pipes repaired, renewed, etc. 20 12 Yards, Areas and Washhouses— Cleansed 9 7 Paved and paving repaired 16 2 Houses and Workshops, etc.— Cleansed 52 41 Dilapidations repaired and made good 41 6 Ventilation improved 2 9 Dampness— Roofs repaired 42 2 Gutters repaired 14 2 Other works to prevent dampness 13 3 Ashbin— Provided, repaired, etc. 32 3 Various— Underground Rooms vacated 6 — Smoke—Emission of black smoke abated — 5 21 Accumulations of Refuse—Removed 28 14 Overcrowding abated 5 1 Animals improperly kept 2 — Manure Receptacles—Provision of — — Statutory Notices. The following table shows the nuisances for which the 45 Statutory Notices were issued under the Public Health (London) Act, 1891: — Houses. Factories, etc Section 2 (1)— (a) Dirty, dilapidated, damp premises, etc. 20 6 (b) W.C.'s, drains, etc. 13 4 (c) Water cisterns and water supply 1 2 (d) Animals improperly kept — — (e) Accumulation of refuse 4 3 (f) Overcrowding 2 — (g) Ventilation — 3 Section 21 (1)—Effluvia — — Section 24—Smoke — — Section 37—Ashbins — — Section 37—Waterclosets — 4 Section 38—W.C. dirty or defective, etc. 5 9 Section 38—W.C. accommodation for sexes — 2 Seotion 96—Underground rooms 1 — By-Laws as to Houses let-in-lodgings. At the end of the year, 460 houses were registered under these By-laws. Of these, 206 were wholly or partly decontrolled under the Kent Act at the end of 1935. There were 739 inspections of these premises, excluding a very large number of periodical inspections and re-inspections. 135 notices were served for breaches of the By-laws, in addition to 460 notices that were served for annual cleansing as required by the By-laws. Rag and Bone Dealers. As a result of the inspections of rag and bone shops made in the year 1935, no breach was found of the By-laws made by the London County Council for regulating the conduct of this business. Rats and Mice (Destruction) Act, 1919. During the year, under the provisions of the above Act, 225 separate premises were inspected, ranging from small dwelling houses to large blocks of offices and business premises. In 97 cases the Inspectors discovered evidence of rat infestation. Notices under the Act were served as necessary, and advice given with a view to adequate steps being taken to eradicate the vermin. In 18 cases traps were used, 23 occupiers laid down poison baits; in 9 cases the Inspectors were informed that 22 cats were kept specially for rat catching. In 16 cases professional rat catchers were employed, and in 60 cases the nuisances were abated following new drainage or other satisfactory methods of rat-proofing. The Rat Officers reported that in a number of cases where no evidence of rats was found at their inspections the satisfactory condition was the result of continued efforts, initiated in previous years for rat repression, such as the regular use of traps, cats, poisons, or the employment of professional rat catchers. The following is a summary in tabular form of the conditions found and action taken in the various wards of the Borough:— Rats and Mice (Destruction) Act, 1919. Summary of conditions found on inspections, action taken and results obtained. WARD. Number of premises inspected. Number rat infested. Action for Rat Repression. RESULT. Traps. Poisons. Rat catchers. Dogs. Cats. Proofing a. 6 2 — 1 — - — 1 Free 2 B. 33 21 — - — — — 21 Free 21 C. 5 3 — 1 1 — 2 1 Free 3 d. 47 16 — 1 1 — — 11 Free 12 Under observation 4 e. 7 2 — — - — — 2 Free 2 F. 28 11 3 3 — — — 6 Free 5 Rats occasionally seen 5 Under observation 1 G. 44 14 2 1 3 - - 8 Free 11 Rats occasionally seen 1 Under observation 2 H. 39 23 11 12 10 - 5 10 Free 23 Under observation 3 I. 16 5 2 4 1 - 2 — Free 5 225 97 18 23 16 - 9 60 Free 81 Rats only occasionally seen 6 Under observation 10 23 National Rat Week. In response to the request of the Ministry of Agriculture and Fisheries, "Rat Week" was observed in the Borough in the week commencing 4th November, 1935. The following is a summary of the action taken:— (i) Posters, principally those prepared by the Minister of Agriculture, were exhibited in suitable positions throughout the Borough. (ii) Letters were addressed to local chemists and hardware dealers inviting them to stock and advertise suitable baits and appliances for killing and trapping rats and mice. (iii) Preparatory visits prior to rat week were made by the District Sanitary Inspectors to places known or suspected to be rat-infested, with a view to advising and arranging for concerted action by the various owners in infested blocks. (iv) Pamphlets and leaflets were distributed giving suggestions for rat destruction and the rat-proofing of premises. (v) The baits in the Council's sewers were increased, 3,000 Ratin baits were laid during Rat Week, followed by 3,000 Ratin baits during the period 25th-29th November. The Borough Engineer reported that rat repression has considerably improved in the Holborn sewers, and during the monthly inspection of the sewers worked in it is unusual to see more than two or three rats at the most. Sewer foremen and the gangers report that the poison used is proving very satisfactory. Drainage Works. Every house in the Borough is connected with the water carriage system for the disposal of sewage. Work connected with new drainage, reconstruction of old systems and alterations to existing drainage, is supervised by the Sanitary Inspectors. During the year 137 applications were received for the Council's approval to proposed drainage and sanitary works. All the applications received were approved, subject in some instances to amendments being made which were necessary in order to secure compliance with the London County Council Drainage By-laws. Smoke Abatement. The smoke shafts in the Borough were kept under frequent inspection, 82 observations being recorded. A number of these were made in the early morning, when smoke pollution is more prevalent; and frequently the observations extended for periods of not less than one hour. Seven complaints were received of nuisances from the emission of smoke. As the result of inspections made, five intimation notices were served. The use of unsatisfactory coal is the common cause of smoke nuisance, such use arises when attempts are made to effect economy in running 24 plant. Usually a visit by the Inspector or a letter from the Medical Officer of Health secures immediate abatement of the nuisance. In accordance with its powers under the Public Health (Smoke Abatement) Act, 1926, the Council made a small contribution towards the cost of the work for smoke abatement carried on by the National Smoke Abatement Society. Inspection of Workshops, etc. The routine inspection of factories, workshops and workplaces has been carried out during the year. 461 factories were inspected, 365 workshops and 4,099 workplaces. It is found that changes frequently occur in the occupation of workshops. To obtain information of such changes and further details of industrial conditions in the Borough a large number of visits and inspections were made in addition to the routine inspections mentioned above. As the result of these visits 38 premises no longer used for the purpose for which they had been registered were removed from the register of workshops. In some cases, owing to the introduction of machinery, former "workshops" had become "factories" and the necessary transfer to the factory register was effected. Variations in the staff employed were also frequently reported. During the year 46 workshops were added to the register. At the end of the year there were 619 workshops on the register. 373 employed men only, 42 employed women only, and 204 employed both men and women. The number of employees is often very small and many of the workshops are in tenement houses (houses let in lodgings). No fewer than 156 different industries are carried on in these workshops, among the principal being the following:— No. of Workshops Employing Men only. Women only. Both Sexes. Total. Boot makers and repairers 14 - 2 16 Builders 12 — — 12 Carpenters 11 — — 11 Clock and watch makers 19 — 1 20 Dressmakers and ladies' tailors — 14 22 30 Diamond mounters 9 — 1 10 Engravers 17 — 2 19 Glass blowers 8 — 2 10 Jewellers 35 2 12 49 Leather goods makers 7 1 5 13 Metal workers 7 — 4 11 Tailors 24 3 48 75 Factories. These visits also afforded an opportunity for extending and revising information relating to "factories" in the Borough. At the end of the year 496 factories were 25 on the register. Workshops are automatically converted, at a very small cost, into factories by the installation of a small electric motor; the health conditions then may no longer be inspected by the Borough Council's staff except as regards sanitary accommodation. The 496 factories include 57 different industries. In 247 cases men only were employed, in 17 women only, and in 232 both sexes. The more important industries carried on in these factories are:— Printing 127 Engineering 42 Jewellers' work 29 Bookbinding 18 Metal work 12 Factory and Workshop Inspection—Summary. The following is a summary in tabular form of the work done by the Inspectors in factories, workshops and workplaces in the year 1935:— Mr. Bennett. Mr. Clark Mr. Larard Mr. Fisher. Miss Charlesworth. Total. Factories— Inspections (including factory bakehouses) 13 31 413 4 — 461 Re-inspections 1 5 16 — — 22 Workshops— Inspections 24 60 255 — 8 347 Re-inspections 5 2 45 — — 52 Workplaces— Inspections 62 92 134 1 2 292 Re-inspections 328 392 302 — — 1,022 Offices— Inspections 7 1 15 — — 23 Re-inspections — — 1 — — 1 Bakehouses— Inspections (excluding factory bakehouses) 6 8 4 — — 18 Re-inspections 3 2 — — — 5 Restaurants— Inspections 137 73 143 102 — 455 Re-inspections 6 13 15 1 — 34 Licensed Premises— Inspections 3 1 5 — — 9 Re-inspections - 4 3 - 7 Defects Found— Want of cleanliness 7 18 16 — — 41 „ ventilation — 7 2 — — 9 Overcrowding — 1 — — — 1 Storage cistern defective 2 2 — — — 4 Accommodation for refuse — — — — — - Accumulation of refuse 2 5 7 — — 14 Sanitary accommodation Insufficient 3 2 2 — — 7 Unsuitable — 4 7 11 Defective 3 5 5 — — 13 Not separate for sexes 1 2 1 — — 4 Other nuisances 11 38 31 - — 80 Total defects 29 84 71 — — 184 26 Action taken. Matters referred to H.M. Inspector:— Failure to affix abstract 3 Matters referred by H.M. Inspector:- Notified by H.M. Inspector 15 Notices served. Mr. Bennett. Mr. Clark. Mr. Larard. Miss Charlesworth. Total. Factories— Intimation — 7 13 — 20 Statutory — — 2 — 2 Workshops— Intimation 10 10 16 — 36 Statutory 1 1 1 — 3 Workplaces— Intimation 6 33 41 — 80 Statutory — 3 8 — 11 Offices— Intimation — — — — Statutory — — — — — Restaurants— Intimation ... 5 8 4 — 17 Statutory — 1 — — 1 Licensed Premises— Intimation — — 2 — 2 Legal Proceedings - - - - - Outworkers. Lists received from Holborn Firms 91 Names and addresses received from other Authorities 436 Names and addresses sent to other Authorities 280 Notices served on Employers 91 Firms visited 77 Infectious diseases in outworkers premises nil Rag Flock Acts, 1911 and 1928. There are no premises in the Borough on which rag flock, as defined by the above Acts, is manufactured, used or sold. The Shops Act, 1934. This Act came into force on the 30th December, 1934. It applies to retail and wholesale shops and warehouses. The Act contains provisions for the health and comfort of shop workers, dealing with ventilation, temperature, lighting, sanitary conveniences, washing facilities and facilities for taking meals, if these have to be taken in the shop. The responsibility was placed on Metropolitan Borough Councils for the administration of the sections dealing with ventilation, heating and the provision of sanitary conveniences. The Act requires adequate means of ventilation and lighting to be provided and maintained and, unless the shop is specially exempt, suitable and sufficient sanitary conveniences must be provided for those employed in or about the shop. 27 During the year 377 inspections were made under this Act; in 36 cases it was found that the requirements respecting ventilation, heating, or the provision of sanitary conveniences were not complied with. In all cases the attention of owners and occupiers was directed to the new law and the necessary steps were taken to effect compliance therewith. In 25 cases on applications from owners or occupiers certificates of exemption under Section 10 of the Act (provision of sanitary conveniences) were granted—in all these cases the Public Health Committee was satisfied that suitable sanitary conveniences could not be provided in the shops but were otherwise conveniently available. Inspection of Private Swimming Baths. In conjunction with the Baths Manager-Engineer a thorough examination has been made of the private swimming baths at the Y.M.C.A. Central Club, Great Russell Street, and Messrs. Bourne and Hollingsworth's, Warwickshire House, Cower Street. In both of these baths, the condition of the water was found to be satisfactory, and the purification plants to be working efficiently. The auxiliary hygienic measures were also satisfactory. Advice to the operators responsible for maintaining the desirable standard of purity and hygiene in the Borough's Private Bathing establishments is given by our Baths Department, as and when required. It would appear desirable for an advisory supervision to be exercised over any projected schemes in the Borough which propose to include private swimming baths. Such an arrangement would ensure that the high standard maintained by existing establishments would be applied to new ones. HOUSING. The following is the summary of information asked for in the Ministry of Health Circular 1492 (England): — I-INSPECTION OF DWELLING-HOUSES DURING THE YEAR. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 709 (b) Number of inspections made for the purpose 891 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 66 (b) Number of inspections made for the purpose 292 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 12 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 223 II.—REMEDY OF DEFECTS DURING THE YEAR WITHOUT SERVICE OF FORMAL NOTICES. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers Not known 28 III—ACTION UNDER STATUTORY POWERS DURING THE YEAR. A.—Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 9 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) by owners 6 (b) by Local Authority in default of owners — B. Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 223 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) by owners 223 (b) by Local Authority in default of owners nil C. Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 3 D. Proceedings under Section 20 of the Housing Act, 1930 :— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 10* (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit nil * In addition, undertakings as to future user of underground rooms were accepted in four cases. Common Lodging-Houses. The Public Health Committee considered and granted applications for the renewal of licences for the renewal of licences fot the twelve months ending 30th June, 1936, in respect of the following common lodging houses:- Premises. Licensed Keeper. Authorised number of Lodgers. Number of Rooms. Males. Females. 7, Short's Gardens William George Parker 70 — 4 35, Devonshire Street Mrs. A. E. Chesterton — 45 9 40, Eagle Street Joseph Benton 50 — 10 Parker Street House Frank Hunt 349 — 10 During the year the common lodging-house at Nos. 1-7, Macklin Street was closed, on the sale of the property by the owners. The number of beds available for males at common lodging-houses was thereby reduced to the extent of 79. 29 Accommodation on L.C.C. Estates. During the year 51 applications for accommodation on L.C.C estates were submitted through the Council's Public Health Department. During the same period information was received of 37 Holborn families for whom accommodation was provided by the London County Council. This arrangement with the L.C.C. is primarily to secure reduction in overcrowding, that is, to provide housing accommodation for families residing more than two per room, but other cases of hardship are also eligible for consideration. With a view to preventing vermin infestation in the Council's dwellings, the homes of applicants are inspected before the tenants are accepted and, in addition, incoming tenants are furnished with a memorandum of advice which is explained to them where necessary by the Public Health Staff. A careful watch is kept by the Sanitary Inspectors and Health Visitors for the appearance of bugs in these dwellings and the tenants are instructed as may be necessary. Holborn Housing Trust, Ltd. In the previous Annual Reports reference was made to the formation of the Holborn Housing Trust under the Presidency of the late Mr. Stuart Bevan. K.C., M.P., and the Chairmanship of Alderman Percy Hill, L.C.C., the objects of the Trust being the erection of working class dwellings in Holborn at the lowest economic rent. The following report is kindly supplied by Mrs. P. J. S. Bevan, the Honorary Secretary of the Trust :— The Committee deeply regrets to report the death of the President, Mr. Stuart Bevan, K.C., M.P. His wise judgment and keen interest will be much missed. They also regret to report the resignation of Councillor Mullen from the Committee, but welcome Mrs. Elliott, the Rev. W. C. Roberts and Mr. E. C. Harris, F.S.I. The Committee has to report a year of steady progress. The tenancies of Bevan House continue unchanged, and are proving most satisfactory. The tenants have expressed their appreciation of the flats and the Committee is grateful to them for some constructive suggestions, many of which will be incorporated in future buildings. The two adjoining houses Nos. 38 and 39, Devonshire Street, have been demolished, and a block of twelve three-roomed flats, with four single-roomed flats at the rear, are now being erected by Messrs. C. P. Roberts & Co., Ltd., to the designs of Messrs. Elcock and Sutcliffe and Mr. R. T. Beck. The estimated cost of these is £8,015, and it is hoped that they will be in occupation by May. The Trust feels particularly satisfied that it is enabled to build these singleroomed flats, as the need for such accommodation is urgent, and much appreciated. Nos. 40, 41 and 43, Devonshire Street have also been acquired by the Trust with a view to development in the near future. The Committee is glad to report that the Holborn Borough Council has appointed a delegate to the Committee with a view to a full use being made of the advantages afforded by the Housing Act of 1935. The Committee is glad of the opportunity of expressing their gratitude to the Holborn Borough Council for their ready co-operation. 30 The Trust is indebted to the Liverpool, Victoria Friendly Society for agreeing to advance 90 per cent, of the necessary funds upon favourable terms, and to the Westminster Bank' Ltd. for financing building operations until the flats are completed. The interest on the Loan Stock has been paid. Housing Act, 1935—Overcrowding Survey. The survey required to be carried out under Section 1 of the Housing Act, 1935, to determine the extent of overcrowding, and the number of new houses required to abate such overcrowding, was commenced in Holborn in May, 1935. The preliminary enumeration was carried out partly by canvassers employed on the annual revision of the register of electors and partly by temporary staff specially engaged for the purpose. For the measurement of rooms temporary survey and clerical assistants were employed. The preliminary survey was completed by the 31st December, 1935, the total cost being £549. 15s. 8d. The results obtained are shown on the form "C" attached to this Report. This form relates to the whole Borough; it will be observed that of the 5,858 families enumerated at the survey, 700 (11.9 per cent.) were found to be overcrowded. The following table shows the distribution of overcrowding in the various Wards of the Borough: — Table I. Extent of Overcrowding in Wards and Borough. Ward. Total families enumerated. Families not overcrowded. Families overcrowded. Families overcrowded. Per cent. A. North St. Giles 18 18 — — B. Central St. Giles 901 773 134 14.9 C. Lincoln's Inn 272 231 44 16.2 D. North Bloomsbury 550 512 39 7.1 E. South Bloomsbury 178 168 10 5.6 F. St. George-the-Martyr 1,171 998 178 15.2 G. North St. Andrew 654 593 61 9.3 H. South-East St. Andrew 2,007 1,788 219 10.9 I. Saffron Hill 107 93 15 14.0 Whole Borough 5,858 5,174 700 11.9 HOUSING ACT, 1935.—OVERCROWDING SURVEY. Distribution of working-class families in relation to size of family and size of dwelling occupied. Metropolitan Borough of HOLBORN. Size of family ("equivalent number" of persons) Size of dwelling occupied, in terms of the maximum "equivalent number" of persons permitted to occupy it without causing it to be overcrowded. Totals of Families. *0 *½ 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 10½ 11 11½ 12 12½ 13 & over Overcrowded. Not Overcrowded. Total. 1 - - 22 383 384 229 136 - 62 10 25 2 13 - 1 - 1 - - 1 2 - - - - - - - 1,271 1,271 1½ - - - 1 4 6 4 - 1 _ _ - - - - - _ - - - - - - - - - - 16 16 2 - - 4 12 †244 577 464 4 194 34 94 3 36 7 7 12 4 1 3 - 3 1 - 1 - - 1 †32 1,674 1,706 2½ - - - 1 31 18 225 - 39 6 35 - 16 1 1 1 _ _ - - - - - - - - - 32 342 374 3 - - - - 42 29 399 1 227 27 121 3 65 11 7 14 12 1 7 1 1 1 - 1 1 - 1 71 901 972 3½ - - - - 5 4 85 2 56 8 33 1 8 2 1 2 1 1 1 - - - - - - - - 94 116 210 4 - - - - 2 9 135 1 24 32 224 2 44 4 4 16 11 2 2 6 2 1 - 2 5 1 2 147 384 531 4½ - - - - - - 34 - 4 4 53 - 11 4 4 7 - - - 2 - - - - - - - 38 85 123 5 - - - - 3 2 39 - 6 12 112 3 27 2 7 11 13 2 7 1 9 2 4 - 1 - 1 62 202 264 5½ - - - - - 1 9 - 3 1 35 1 12 5 2 2 _ 1 - 2 - - - 1 - - 1 49 27 76 6 - - - - - - 18 - 2 2 49 _ 6 13 5 27 4 _ 4 3 5 2 1 - 3 - - 71 73 144 6½ - - - - - - 6 - - 1 14 1 1 5 - 5 — - 2 - 1 1 1 - - - - 23 15 38 7 - - - - - - 3 1 - - 25 1 1 3 4 4 2 - 1 4 2 3 - 1 1 - 2 34 24 58 7½ - - - - - - 1 - - - 9 - 1 2 2 6 1 - 2 - - 1 - - - - - 15 10 25 8 - - - - - - 1 - - 1 5 _ _ 3 1 3 - 1 - 1 1 1 - - 1 - 2 14 7 21 8½ - - - - - - 1 - - - 1 - - 1 3 1 - 2 - - - - - - 1 - - 7 3 10 9 - - - - - - - - - - 2 - - 1 - 1 - 2 - - - 2 - _ - 2 6 4 10 9½ - - - - - - - - - - 2 - - - - - - - - - - - - - - 1 - 2 1 3 10 - - - - - - - - - - - - - - - - - 1 1 - - 1 1 - - - 1 2 3 5 10½ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11 - - - - - - -- - - - _ _ _ _ - _ _ _ 1 - - - - - - - - 1 - 1 11½ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12 - - - - - - - - - - - - - _ _ _ - - - - - - - - - - - - - - 12½ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 13 & over - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TOTALS OF OWELLINQS OVERCROWDED - - 4 13 †99 45 332 2 15 17 142 2 3 10 6 5 _ 3 2 - - - - - - - - †700 NOT OVER CROWDED - - 22 384 616 830 1,228 7 603 121 697 15 238 54 43 107 49 11 29 21 26 14 9 6 13 2 13 5,158 TOTAL - - 26 397 715 875 1,560 9 618 138 839 17 241 64 49 112 49 14 31 21 26 14 9 6 13 2 13 5,858 * 0 = a dwelling of 1 room under 50 square feet: ½ = a dwelling of 1 room between 50 and 70 square feet. † Including 16 families with insufficient accommodation to secure proper sex separation and for that reason overcrowded. 31 Overcrowding in Municipal Housing Estates. The following table shows the extent of overcrowding found in the Municipal Estates in the Borough. It will be observed that the overcrowding on these Estates was equivalent to 18.3 per cent, of the total overcrowding in the Borough. Table II. Extent of Overcrowding in Municipally Owned Estates. Estate. Families enumerated. Families not overcrowded. Families overcrowded. Families overcrowded. Per cent. London County Council:— (a) Bourne Estate 763 689 74 9.7 (b) Herbrand Street Estate 159 139 20 12.6 (c) Macklin Street Estate 62 53 9 14.5 (d) Cranley Buildings 12 10 2 16.6 Total L.C.C. Estates 996 891 105 10.5 Holborn Borough Council:— (a) Betterton House 30 23 7 23.3 (b) Boswell House 62 46 16 25.8 Total H.B.C. Estates 92 69 23 25.0 Corporation of London:— (a) Viaduct Buildings 39 39 - - Total City Corporation 39 39 — — Grand Totals 1,127 999 128 11.4 Estimate of New Houses Required. An estimate of the number of new houses required to abate overcrowding in the Borough was prepared from the results of the survey. The estimated accommodation required is as follows:- Size of tenement. No. required. 3 rooms 111 4 „ 54 5 ,, 54 6 ,, 8 7 ,, 5 8 ,, 2 Total 234 In calculating the above estimate, due allowance has been made for housing accommodation likely to be provided for the purposes of the Housing Act, 1930, and also for a proportion of the vacant accommodation found to exist at the survev. 32 Proposals for the Abatement of Overcrowding. The Housing of the Working Classes Committee of the Council have for some time past been giving much thought and attention to the matter of the provision of new housing accommodation both for the abatement of overcrowding and for the purpose of rehousing of persons displaced under the Housing Act, 1930. There are many difficulties in the way of securing suitable sites in a Borough like Holborn, where land values are very high and the whole of the small area is built on. Proposals are at present under consideration, however, for the erection of flats on two sites, but these are not yet sufficiently advanced for details to be given. It is hoped that in the report for 1936 it will be possible to record a considerable advance in connection with the provision, of new housing accommodation. A considerable proportion of the new housing accommodation for abatement of overcrowding in London will be provided by the London County Council, from which Holborn may expect to benefit in common with the other metropolitan City and Borough Councils. Rehousing. During the year the Council entered into an agreement with the London County Council for provision of rehousing accommodation for families displaced by the Council's operations under the Housing Act, 1930, subject in each case to a contribution of £1. 17s. fid. per annum being paid by the Council to the London County Council for a period of forty years. The agreement as originally proposed was for a period of one year, but during 1935 information was received from the London County Council that it had been decided to continue the arrangement until further notice. During the year 1935 three cases were approved by the Council for inclusion in the agreement and of these one family had been rehoused at the end of the year. INSPECTION AND SUPERVISION OF FOOD. Dairies, Cowsheds and Milkshops. In connection with the duties imposed on the Council respecting registration of milkshops, opportunity is taken before entering the premises or the name of the applicant on the register to inspect the premises proposed to be used, to ascertain whether they are suitable for the sale of milk. From time to time it has been necessary to postpone registration pending the completion of works found to be required. At the end of the year 1935, the number of registered dairies and milkshops in the Borough was 152. Eight entries were made in the register during 1935. Of these, 3 were cases where a change of occupier had necessitated re-registration, and 1 was a new registration of an itinerant vendor with premises outside the Borough. The Sanitary Inspectors recorded 207 inspections of milk premises. It, was not necessary to serve notice for any breach of the Order or sanitary defect. 33 The Milk (Special Designations) Order, 1923. During the year 1935 licences available up to the 31st December, 1935, for the sale of designated milk in the Borough were issued as follows:- Certified 2 Grade A (Tuberculin Tested) 2 Grade A (Pasteurised) 1 Pasteurised 8 Supplementary— Grade A (Tuberculin Tested) 1 Pasteurised 3 37 Bacteriological Examination of Milk. Twenty-five samples of milk were examined for the presence of tubercle bacillus. The animals inoculated with respect to these milks were killed at the end of six weeks. It is satisfactory to record that in no case was any evidence disclosed of tubercle infection. Cleanliness of Milk. Eight of the twenty-five samples mentioned above were also examined to ascertain the number of organisms per cubic centimetre and the smallest volume containing coliform bacillus. The results of these examinations are shown in the following table:- Date of sample obtained. Nature of shop where purchased. Grade No. of organisms per c.c. grown at 37C for 24 hours. Minimal volume containing Bacillus Coli. 1935 10th July Dairy Ungraded 300,000 Present in 0.001 c.c. 14th August Restaurant Ungraded 4,500 Absent in 1 c.c. 11th September School Pasteurised 67,000 Present in 0.01 c.c. Do. Dairy Grade A. (T.T.) 19,000 Present in 0.01 c.c. 1 tube 9th October Dairy Certified 250,000 Absent in 2 tubes Present in 0.1 c.c. 2 tubes 29th Do. Dairy Certified 20,800 Absent in 0.1 c.c. 3 tubes Do. Dairy Grade A. (T.T.) 850 Absent in 0.01 c.c. 3 tubes Do. Dairy Grade A. (T.T.) 3,180 Absent in 0.01 c.c. 3 tubes It will be seen that one sample purchased from a dairy failed to comply with the conditions laid down by the Milk (Special Designations) Order, 1923. This sample was found to contain 250,000 organisms per c.c. in comparison with 30,000 permitted by the Order. Also Bacillus Coli was present in 0.1 c.c. Letters were c 34 addressed to the Vendor and the) Wholesalers, drawing attention to the matter, and information was also sent to the Medical Officer of Health of the district in which the producing farm was situated. A further sample of certified milk taken subsequently from the same dairy was found strictly to comply with the requirements of the Order. Public Health (Dried Milk) Regulations, 1923. Very few brands of dried milk are sold in the Borough. Five samples were obtained during the year and found to comply with the Regulations, which are generally similar to those with regard to condensed milk. Margarine. There are eight registered wholesale dealers in the Borough. Bakehouses. At the end of the year 1935 there were 19 bakehouses in the Borough of which 13 were factory bakehouses. Although these are described as "factories" they are not large and only supply local needs; a number were formerly workshops and are now classified as " factories " owing to the installation of machinery. During the year, in addition to my inspections, there were 32 inspections of bakehouses, and three notices were served. Sale of Fish. During the past year 19 inspections were made of the fish shops and fish stalls in the Borough, exclusive of market street inspections. There were 13 fish shops, of which eight were in the Central Fish Market (a part of the Smithfield Central Markets, Farringdon Road, the fish being sold by retail). Both wet and dried fish were found to be sold at all the shops; at five, shell fish was also sold. In addition to the shops referred to above, there are eight stalls in the Borough for the general sale of fish. There is also a shop in the Borough for the sale of shell fish only and two for the sale of stewed eels. These premises were also kept under observation. Fried Fish Shops. There are also 15 fried fish shops. These are regularly inspected to see that they are kept in conformity with the By-laws made by the London County Council. 35 During the past year 272 inspections of these premises were made. At the same time a careful look-out has been kept on the soundness of the fish and the wholesomeness of the materials used for frying. Market Streets. There were 1,102 inspections of market streets, each of which includes a number of stalls at which meat, fish, fruit and vegetables are sold. These streets are regularly inspected daily and on Saturday evenings. In order to minimise as far as practicable any contamination of the food exposed for sale in market streets from dust arising during street cleansing, the Borough Surveyor has arranged for these streets to be sufficiently watered before the scavenging to prevent dust arising. Street Trading. I received information from the Borough Engineer respecting 92 tions from street traders for annual licences to sell various articles of food as follows:- Coffee stalls 5 Confectionery and drinks 12 Fish—wet and dry, including shell fish 7 Fruit and vegetables 47 Groceries 4 Ice cream or chestnuts 10 Meat 3 Poultry, eggs and provisions 4 92 All the storage places situated in the Borough were inspected. Where the storage place is outside the Borough information as to suitability is obtained from the Medical Officer of Health of the district concerned. In like manner information respecting storage places in Holborn used by stallholders trading in other areas is sent to the Medical Officer of Health of the district in which the licence is applied for. c2 36 Ice Cream. At the end of the year the following premises were on the register:- Manufacture only 1 Manufacture and storage 1 Manufacture and sale — Manufacture, storage and sale 20 Storage and sale 3 Sale only 21 46 In addition to my inspections, 51 inspections of these premises were made. Where ice cream sold in the Borough is made at premises outside Holborn, it is the practice to ask for information as to the conditions of manufacture from the Medical Officer of Health of the area concerned. On the other hand, we receive a number of such enquiries from other districts respecting ice cream made in Holborn and sold in other districts. Public Health (Meat) Regulations, 1924. The following summary shows the number of butchers' shops and meat stalls in the Borough, and the number of other shops where meat is sold:- Butchers' shops 27 Butchers' stalls 1 Provision dealers 35 Provision dealers' stalls 3 Offal shops 3 Cooked meats 19 Wholesale (bacon; sausage) 5 93 All the butchers' shops and meat stalls in the Borough are regularly inspected to ensure compliance with the Regulations; during the year 595 such inspections were made. Places where Food is prepared for Sale. Under this head are included kitchens of hotels, restaurants and eating-houses of all sorts, slaughter-houses, tripe, offal and other meat shops, fried fish, eel and other fish shops, premises where ice cream is made, and other places where food as prepared for sale, excluding bakehouses. 37 The number of such places on the register at the end of the year was as follows :— Hotels, Restaurants and Eating Houses 309 Slaughter-houses 1 Tripe, offal and other meat shops 48 Fried fish shops 15 Fish shops 13 Ice cream (Manufacture) 22 Poulterers 8 During the year 2,490 inspections of such food premises and market streets were made and 27 notices served for sanitary defects found. Inspection of Restaurant Kitchens. The large day population in the Borough calls for many eating houses ranging from the "cook shop" to the high-class restaurant. The inspection of the kitchens of such places has become a routine but important part of the work of the Public Health Department. Generally the kitchens are found to be satisfactory and the food clean and wholesome. Occasionally, however, some action is necessary to ensure compliance with a reasonable standard of efficiency. In all 21 notices were served during the year respecting unsatisfactory conditions at hotels, restaurants and eating houses. Unsound Food. The following unsound food was condemned during the year 1935:- Commodity. Quantity. Condition. Result of Action taken. Tons. Cwts. Qrs. lbs. Fruit :— Cantaloupe melons ... 1 0 0 Rotten Surrendered Dates ... ... ... 6 Rotten do Grapes ... 1 2 12 Rotten do. Oranges 18 5 0 20 Rotten do Pears 1 11 0 8 Rotten do. Plums ... ... 2 4 Rotten do. Meat :— Bacon ... ... 3 8 Decomposed do. Chickens ... ... 1 17 Decomposed do. Ducks ... ... ... 15 Decomposed do. Ostend Rabbits ... ... ... 8 Decomposed do. Pork • •• ... ... 20½ Diseased do. Tongues, tinned ... ... ... 12 Mouldy do. Other Food :— Camembert cheese ... ... 2 16 Rotten do. Tomato puree, tinned ... ... 2 19 Damaged and perforated tins do. Total 20 2 1 25½ 38 The Public Health (Preservatives, etc., in Food) Regulations. In the year 1935 two samples of food were found on analysis to contain preservatives contrary to the provisions of the above Regulations, viz., vinegar and ginger wine (see page 42). Food and Drugs (Adulteration) Act, 1928. Articles Analysed. Formal Samples. Article. Number Purchased Result of Analyses Proceedings taken. Convictions. Fines and Costs. Genuine. Adulterated. Ale 3 3 ... ... ... ... Amm. tincture of quinine 3 3 ... ... ... ... Apricots, canned 1 1 ... ... ... ... Arrowroot 2 2 ... ... ... ... Asparagus, canned 2 2 ... ... ... ... Baking powder 1 1 ... ... ... ... Beans, canned 2 2 ... ... ... ... Beef, corned s 3 ... ... ... ... Beef, minced 2 2 ... ... ... ... Bicarbonate of soda 3 3 ... ... ... ... Borax, powdered 2 2 ... ... ... ... Brawn 6 6 ... ... ... ... Brandy 2 2 ... ... ... ... Bread and butter 4 4 ... ... ... ... Buns, cream 4 3 ... ... ... ... Butter 39 39 ... ... ... ... Cake 4 4 ... ... ... ... Cheese 15 15 ... ... ... ... Cheese, cream 2 2 ... ... ... ... Chicken broth 1 1 ... ... ... ... Chocolate 3 3 ... ... ... ... Cocoa 2 2 ... ... ... ... Coffee 2 2 ... ... ... ... Coffee and chicory 2 2 ... ... ... ... Coffee extract 1 1 ... ... ... ... Coffee and chicory extract 2 2 ... ... ... ... Cornflour 3 3 ... ... ... ... Cream 8 8 ... ... ... ... Cream, canned 3 3 ... ... ... ... Cream, coffee 2 2 ... ... ... ... Dripping 5 5 ... ... ... ... Egg substitute 4 4 ... ... ... ... Fish paste 4 4 ... ... ... ... Gelatine 2 2 ... ... ... ... Gin 2 2 ... ... ... ... Grape fruit squash 1 1 ... ... ... ... Ice cream 7 7 ... ... ... ... Jam 6 6 ... ... ... ... Lard 1 1 ... ... ... ... Lemon and barley 1 1 ... ... ... ... Lemonade 1 1 ... ... ... ... Lemonade powder 3 3 ... ... ... ... Lemon crush l 1 ... ... ... ... Lemon squash 4 4 ... ... ... ... Lime juice cordial 3 3 ... ... ... ... Liniment of turpentine 2 2 ... ... ... ... 39 ARTICLE. Number Purchased. Result of Analyses. Proceedings taken. Convictions. Fines and Costs Genuine. Adulterated. Linseed, crushed 3 3 ... ... ... ... Margarine 19 19 ... ... ... ... Marmalade 8 8 ... ... ... ... Meat, minced 2 2 ... ... ... ... Meat paste 2 2 ... ... ... ... Meat pie 1 1 ... ... ... ... Meat sausage 1 1 ... ... ... ... Milk 211 206 5 2 1 (l) Summons withdrawn on payment of £ 1, 1s. Costs (ii) Fine 40s. Costs 21s. Milk, condensed 4 4 ... ... ... ... Milk, dried 5 5 ... ... ... ... Mineral water 1 1 ... ... ... ... Mustard 2 2 ... ... ... ... Oil, almond 3 3 ... ... ... ... Oil, camphorated 2 2 ... ... ... ... Oil, olive 2 2 ... ... ... ... Oil, salad 3 3 ... ... ... ... Ointment, boracic 2 2 ... ... ... ... Ointment, white precipitate 3 3 ... ... ... ... Orange squash 2 2 ... ... ... ... Peaches, canned 2 2 ... ... ... ... Peas, canned 11 11 ... ... ... ... Pickles 3 3 ... ... ... ... Pies, mince 3 3 ... ... ... ... Prescriptions 5 5 ... ... ... ... Puddings, Christmas 3 3 ... ... ... ... Rhubarb, comp, tinc, of 3 3 ... ... ... ... Rum 2 2 ... ... ... ... Sauce 2 2 ... ... ... ... Sausage 12 12 ... ... ... ... Sausage, cooked 1 1 ... ... ... ... Sausage roll 1 1 ... ... ... ... Soup, kidney 1 1 ... ... ... ... Soup, oxtail 1 1 ... ... ... ... Sponge cakes 2 2 ... ... ... ... Sponge fingers 2 2 ... ... ... ... Stomach powder 1 1 ... ... ... ... Suet, shredded 5 5 ... ... ... ... Sugar 3 3 ... ... ... ... Sweets 7 7 ... ... ... ... Tea 3 3 ... ... ... ... Tomatoes 3 3 ... ... ... ... Tonic, orange and quinine 1 1 ... ... ... ... Treacle 2 2 ... ... ... ... Veal, jellied 1 1 ... ... ... ... Vinegar 9 8 1 ... ... ... Whisky 2 1 1 ... ... ... Wine, ginger 2 1 1 ... ... ... Wine, orange and quinine 1 1 ... ... ... ... Wine, raisin 1 1 ... ... ... ... Total 547 538 9 2 1 ... 40 Informal Samples. article. Number of Samples Taken. Result of Analyses. Genuine. Adulterated. Anchovies (canned fillets) 1 1 ... Bananas (sundries) 1 1 ... Cream bun 1 ... 1 Bun flour 1 1 ... Cheese 1 1 ... Cinnamon, ground 2 2 ... Cookeen 1 1 ... Crab, dressed, canned 1 1 ... Cream, canned 1 1 ... Cream, horseradish 2 2 ... Cream, salad 2 2 ... Custard powder 1 I ... Compound syrup of figs 1 1 ... Fish paste 1 1 ... Fruits, crystallised 2 2 ... Ginger, ground 2 2 ... Honey 2 2 ... Hors d'oeuvres 1 1 ... Iodine 1 1 ... Milk 7 6 1 Milk, condensed, sweetened, skimmed 1 1 ... Oil, olive 3 3 ... Oil, salad 1 1 ... Ointment, boracic 1 1 ... Peas, canned 1 1 • •• Prawns, bottled 1 1 ... Salmon, canned 1 1 ... Sauce, mint 1 1 ... Sild, canned 2 2 ... Soup, tomato, canned 1 1 ... Sweets 3 3 ... Vinegar 3 3 ... Wafers 1 1 ... White wine, British 1 1 ... Total 53 61 2 Notes of the Borough Analyst on Samples Examined During the Year 1935. During the year 1935, 601 samples were submitted to me for analysis in accordance with the provisions of the Food and Drugs (Adulteration) Act, 1928, 548 having been purchased with the required formalities and 53 obtained informally. Of this total 11 (1.8 per cent.) proved to be adulterated, nine being samples submitted formally and two informally. In the previous year 2.83 per cent, of the samples were certified to be " not genuine." The adulterated articles consisted of Milk, Cream Buns, Ginger Wine, Vinegar and Whisky. Milk.—Two hundred and eighteen samples of the milk were analysed and six of these (2.8 per cent.) fell below the limits required by the Board of Agriculture Regulations—3.0 per cent, of fat and 8.50 per cent, of non-fatty solids—and were certified to be adulterated accordingly. One sample had been diluted with water to the extent of at least 2.3 per cent, and from the five others fat had been abstracted to the extent of from 2.6 to 25.3 per cent, respectively. It may be of interest here to insert two tables prepared by the Public Health Department from the returns of the Borough Analyst showing (1) the Fat Content of the 218 samples of Milk indicating their places of origin, and (2) the Monthly Variation in the Chemical Composition. 41 No.1. Fat Content. Percentage of Fat Number of Samples. Shops. Restaurants Streets. School. Total Less than 3.0 3 ... 1 1 6 3.0 3 ... ... ... 3 3.1 7 ... 1 1 9 3.2 13 ... 5 2 20 3.3 17 2 10 2 31 3.4 26 3 11 1 41 3.5 21 2 6 ... 29 3.6 18 2 4 ... 24 8.7 15 ... 3 ... 18 3.8 9 ... 3 1 13 3.9 5 ... ... ... 5 4.0 2 ... ... ... 2 4.1 8 ... ... ... 8 4.2 1 ... ... ... 1 4.3 2 ... ... ... 2 4 .8 1 ... ... ... 1 4.9 1 ... ... ... 1 5.4 ... 1 ... ... 1 5.6 2 ... ... ... 2 5.7 1 ... ... 1 7.4 1 ... ... ... 1 Total Samples 156 10 44 8 218 Average fat content 3.60% 3.64% 3.40% 3.23% 3.55% No. 2. Monthly Variation of Chemical Composition of Milk. Month. Number of Samples examined. Total Solids. Per cent, average. Solids Non-fat. Per cent, average. Fat. Per cent, average. January 23 12.32 8.90 3.42 February 20 12.19 8.78 3.41 March 22 12.30 8.86 3.44 April 20 12.10 8.82 3.28 May 18 12.54 8.96 3.58 June 18 12.39 9.01 3.38 July 13 12.46 8.98 3.48 August 20 12.60 8.93 3.67 September 18 12.72 8.97 3.75 October 20 12.73 8.90 3.83 November 16 12.87 9.11 3.76 December 10 12.74 9.06 3.68 Whole year 218 12.48 8.93 3.55 Legal minimum ... 11.50 8.50 3.00 42 It will be observed that the average composition of the milk supplied to the Borough during the year was fat 3.55 per cent, and non-fatty solids 8.93 per cent. These figures approximate very closely to those of last year when the fat was 3.52 per cent, and the non-fatty solids 8.95 per cent. In the first table of tabulated results, it will be noted that an addition has been made by including the milk supplied to schools separately and though only a few samples have been examined, it is obvious that more should be taken, as the average fat content of the eight samples was only 3.23 per cent., a considerably lower figure than the 3.55 per cent, of the rest of the Borough—practically 10.0 per cent. less. It it needless to add that the desirability of making this daily addition to the diet of school children is being increasingly recognised. Cream Buns.—Two of the five samples of cream buns submitted during the year were found to be quite innocent of any fat derived from milk and were certified accordingly. Attention must again be called to the apparent unfairness which permits vendors to sell articles so widely different in composition under the same name. Ginger Wine.—A sample of ginger wine was found to contain 30 parts per million of sulphur di-oxide in excess of the limit prescribed by the Public Health (Preservatives, etc., in Food) Regulations. Sulphite preservative is permitted to be added to non-alcoholic wines, provided the quantity added does not exceed 350 parts per million expressed in terms of sulphur di-oxide. Vinegar.—One of the samples of vinegar was found to contain sulphite preservative equal to 82 parts per million of sulphur di-oxide and was certified accordingly. The Preservative Regulations do not provide for the addition of any preservative to vinegar as the acetic acid present should be sufficient to prevent fermentation or changes of like nature. Whisky.—One sample of whisky was slightly below strength. Whisky should not be sold at a lower strength than 35 degrees under proof without notice to the purchaser. In this case the sample proved to be 36.27 degrees under proof and therefore contained 1.27 degrees of proof spirit less than it should have done. Once again it is desirable to point out the necessity for the appointment of some independent body whose duty it should be to make or revise standards for the sale of articles of food, and to prevent as far as possible the sale of very inferior articles for the genuine products. Thus, for instance, at the present time there are varieties of cream, some containing as little as 12 per cent, of milk-fat whilst the genuine article should contain at least 50 per cent. It may be said that these varieties of cream are sold under such names as "Fruit Cream" or "Coffee Cream," but a very large number of purchasers have no idea what they are paying for, and in many cases regard all sorts just as "cream." A variety of other articles might be enumerated but this one example is sufficient to indicate once more the need of some definite pronouncement on the whole question of Food standards. 43 Merchandise Marks Act, 1926. The Orders under the above Act now in force provide for the marking of the following imported foodstuffs to show their origin :— 1. Fresh Apples. 2. Raw Tomatoes. 3. Eggs (hen or duck eggs in shell). 4. Dried Eggs. 5. Currants, Sultanas and Raisins. 6. Oat Products (oatmeal, rolled oats, oat flour and groats). 7. Honey. 8. Salmon or Sea Trout, frozen or chilled. 9. Butter. 10. Bacon and ham. 11. Dead poultry. 12. Frozen beef, mutton, lamb, pork and veal; chilled beef; salted beef and pork; boneless beef and veal; edible offals. During the year under review 315 inspections under the Orders in force were made by the Inspectors appointed for the purposes of the Act, resulting in the detection of 32 breaches of the Orders. In 31 of these cases the breach was remedied following a verbal caution from the Inspector, while in the remaining case it was found necessary to address a cautionary letter to the offender before compliance with the particular Order in question could be secured. London County Council (General Powers) Act, 1932. Registration of Food Premises. At the date of the preparation of this report 43 premises were registered in accordance with the requirements of the Act, for the purposes shown below:— Sausages 19 Preserved meat 20 Pickled meat 7 Preserved fish 1 All the premises concerned were carefully inspected prior to registration. Notification of Food Poisoning. The London County Council (General Powers) Act, 1932, requires medical practitioners to notify all cases of food poisoning occurring in their practice. This early information enables prompt measures to be taken for dealing with any suspected source of infection. Information of all cases in the County of London is distributed to medical officers of health by the London County Council. No case of food poisoning was notified in Holborn during 1935. Slaughter of Animals Act, 1933. One application was received and granted from a slaughterman for renewal of licence to slaughter under Section 3 of the Act. 44 PREVALENCE OP AND CONTROL OVER INFECTIOUS DISEASES, ETC., INCLUDING TUBERCULOSIS. The relative importance of the commoner infectious diseases as regards numbers of deaths caused is shown by the following table:— ENGLAND AND WALES. Common Infectious Diseases. Deaths at all Ages. 1925. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. Yearly average 1925-1934 Pneumonia (all forms) 36,990 32,339 37,242 31,014 43,846 27,724 33,573 29,588 30,059 34,131 Pulmonary Tuberculosis 32,382 30,108 31,066 29,799 31,425 29,414 29,658 27,627 27,854 30,202 Measles 5,337 3,483 3,622 4,302 3,388 4,188 3,288 3,411 1,937 3,779 Whooping Cough 6,058 4,118 3,681 2,976 6,332 2,037 2,512 2,956 2,270 3,692 Diphtheria 2,774 2,994 2,732 3,191 3,446 3,497 2,673 2,339 2,646 2,879 Scarlet Fever 988 677 579 580 717 740 540 530 729 697 Enteric Fever 388 367 367 438 382 313 251 258 222 348 CORRECTION The table on p. 44 should be corrected as to the two columns nearest the top of the page (one of which is blank) as follows:- 1934 YearlyAverage, 19251934 Pneumonia (all forms) 28,623 33,100 Pulmonary Tuberculosis 25,682 29,502 Measles 3,768 3,672 Whooping Cough 2,049 3,499 Diphtheria 4,085 3,038 Scarlet Fever 963 704 Enteric Fever 134 312 45 The total number of notifications relating to Holborn residents received during the year was 383 in comparison with 411 in the year 1934. The following are the principal variations: — Scarlet Fever 50 in comparison with 115 in 1934. Tuberculosis 73 ,, ,, 89 ,, Whooping Cough 99 ,, ,, 65 „ Diphtheria 93 ,, ,, 74 ,, A special reference card with complete list of notifiable diseases is supplied to all doctors practising in the Borough. In addition to the above we received 250 notifications respecting patients not residing in Holborn, many being in-patients of hospitals in the Borough. All these were forwarded to the Medical Officers of Health of the districts concerned. The diseases notified were :— Chicken-pox 3 Diphtheria 72 Erysipelas 1 Measles 10 Scarlet Fever 41 Tuberculosis 62 Whooping Cough 41 Pneumonia 7 Acute Poliomyelitis 1 Encephalitis Lethargica 1 Dysentery 10 Mumps 1 250 Smallpox. No case of smallpox occurred in a Holborn resident during the year 1935. Vaccination. The following table gives information respecting the vaccination of children born in the Borough during the year ended 30th June, 1935: — Total Number of Births Vaccinated Died before Vaccination Cons. Objections Insusceptible Postponed by Medical Certificate Removed. No information as to Vaccination Temporarily unaccounted for Holborn Sub-District: 12 months ended 30th June, 1935 81 50 2 14 0 2 13 0 St. Giles and Bloomsbury Sub-District : 12 months ended 30th June, 1935 51 25 4 11 0 0 10 1 132 75 (57%) 6 25 0 2 23 1 46 During the same period 144 births were transferred to Holborn of children born in various institutions outside the Borough, Holborn being the district of the usual or last known home address of the mothers. Of the 144, at the date of the preparation of this report, 58 (40 per cent.) were known to be vaccinated. The remainder are accounted for as follows:- Removed from the Borough—no information as to vaccination 44 Conscientious objections—Exempted 12 Died before vaccination 10 Postponed—medical certificate 2 Not traced—incorrect address—no information obtained 12 Temporarily unaccounted for 6 As in previous years a leaflet respecting the advantages of vaccination was sent to the parents of all infants born in, or belonging to, the Borough. No opportunity is lost of speaking about the vital importance of vaccination whether for the baby or for the older person. Following the arrangements operating in previous years, information of all cases of smallpox in the Greater London area, giving particulars of the illness and the names and addresses of contacts was distributed to the Borough Medical Officers of Health by the Medical Officer of the London County Council. Diphtheria. We received notifications relating to 93 cases of diphtheia occuring in residents in the Borough. Ninety-two were removed to hospital. Age at Notification of 93 Notified Cases of Diphtheria. 0—1 1—5 5—15 15—35 35—45 45—65 Total. 1 31 39 18 2 2 93 Two deaths occurred. Eleven of the notified cases were returned from hospital certified as not suffering from diphtheria. 47 Secondary clinical cases were six in number; details follow:- Primary Case Age Date notified Secondary Case Age Date notified Remarks e.g. Character of Premises H. C 4 27/2/1935 A. C. 3 27/2/1935 Flat, business premises J. D. 2½ 11/4/1935 M. P. 9 13/4/1935 Flat in dwellings D. P. 7 15/4/1935 C. L. 17 16/4/1935 H. B. 12 18/4/1935 Flat in dwellings H. M. 10 8/6/1935 F. M. 7 10/6/1935 Flat, business premises H. M. 35 12/6/1935 There was no "return" case, i.e., no secondary case was notified from any family within four weeks after the return home of a primary case. In London, 9,294 cases were notified, giving rise to 271 deaths. We endeavour to co-operate with the Medical Superintendents of the Fever Hospitals serving the County of London; and information is now sent to them as to any bacteriological examinations before admission or after discharge of the patients, and also with regard to return cases of diphtheria or scarlet fever. Diphtheria in Hospitals. Information was received of 93 cases of diphtheria occurring among inpatients and staff at three hospitals in the Borough. The information was obtained from the notifications of removal received from the London County Council, or from the ordinary notification certificates furnished by the doctors diagnosing the disease. All the 93 were clinical cases (24 were notified "nasal"). Of the total number, eight notifications related to Holborn residents, all being members of the resident medical or nursing staff. Eighty-five were in-patients admitted from areas outside the Holborn Borough. Copies of the notifications of these cases if sent to the Holborn Public Health Department are forwarded to the Medical Officers of Health of the districts from which the patients are admitted. Diphtheria in Hospitals. Hospital. Cases Notified. Disease Notified as Holborn Cases. NonHolborn Cases. Total. Staff. Inpatients. Clinical. Carrier. A. 5 70 74 1 5 70 75 B. - 10 9 1 - 10 10 C. 3 5 8 - 3 5 8 48 Diphtheria Contacts. Analysis of the swab results relating to the contacts is given below:- Contacts swabbed. Nose and Throat. Positive Results. Throat only. Contacts positive. Nose only. First Examination 71 4 20 2 26* Second ,, 21 - 9 - 9 Third „ 9 - - - - * 4 positive contacts removed to L.C.C Fever Hospital and 1 to General Hospital The parents or others in charge of children harbouring diphtheria bacilli were given written directions as to the precautions necessary. The results of the examinations of child contacts were communicated to the School Medical Department of the London County Council so that children harbouring diphtheria bacilli could be kept from school if there was evidence that the organisms were virulent. Diphtheria antitoxin was available free of charge on application by medical practitioners. 50,000 units were supplied for three cases. Diphtheria "Carriers." Information was received from the School Medical Officer (L.C.C.) of four children excluded from school as suspected diphtheria "carriers." The Schick Test and Immunisation against Diphtheria. This work has been carried on since 1922 at the Council's Maternity and Child Welfare Centre, 10, John Street, on Wednesday afternoons. Enquiries as to the effect of the testing and inoculation on the individual were made as a routine; we are able to record that any disturbance caused was negligible. The use of toxoid antitoxin does away with the risk of accident incurred by using improperly-made toxin antitoxin. TABLE I. Schick Test and Diphtheria Immunisation. Thirteen years, 1922-35. a Total number of individuals who attended clinic b Total tested c Total immunised without preliminary Schick test Result of Test d E Found NEGATIVE to He Schick Test after Immunisation of Positives f Found NEGATIVE to Be Schick Test after G First immunised with T A. F. and found NEGATIVE to lie Schick after h Found POSITIVE to Re Schick Test after 2 ccm T. A. M. or with T.A.F. I Total Re Schick tested j Positive. Negative Not read. Given 3 ccm T.A.M. or with T.A.F. Not retested. Given 1 ceem not yet retested. Failed to complete 3 inoculatns. Inoculatns. not begun. Inoculatns. still in progress 1 cem T.A.M. 2 cem T. A.M. 3 cem T.A.M. or with T.A.F. 4 cem T.A.M. 5 cem T.A.M. 6 cem T.A.M. 8 cem T.A.M. Further doses of T.A.F. 3 cem T.A.M. Given further inoculation but not yet retested. No further inoculation given. Children Adults C A C A C A C A C A C A C A C A C a C A C A C A C A C A C A C a C a C a C A C a C a C a 2057 420 1400 417 658 2 1007 226 384 188 9 3 25 2 28 3 1026 111 22 2 9 1 11 0 1 0 3 0 4 0 31 6 10 5 1169 131 274 59 22 2 100 25 90 20 1 0 2,477 1,817 660 1,233 572 12 27 31 1,137 24 10 11 1 3 4 37 15 1300 †† 333 § 24 125 † 110† 1 1,893 * These columns refer to 105 cases—92 were Schick positive on retesting after 3 cem T. A.M. 13 were Schick positive on retesting after T. A.F. † 91 of these removed from the Borough. § 52 of these have removed from the Borough. †† These retests include those made up to 11th March, 1936. Note.—Columns e f g h give details of the total 1,300 given in Column i. Columns I J give details of the total 1,893 positives given in Column C D We have not altered the routine procedure, except that owing to the increased confidence of the public in the measure we no longer find it necessary to test children under 5 years of age, but proceed in most cases at once to the immunisation. D 50 TABLE ii. Summary. Ages. 6 to 12 months 1 to 2 years 2 to 3 years 3 to 4 years 4 to 5 years 5 to 6 years 6 to 7 years 7 to 8 years 8 to 9 years 9 to 10 years 10 to 11 years 11 to 12 years 12 to 13 years 13 to 14 years 14 to 15 years Adults 15 and above years Total Schick Tested = 1817 Total for 13years, 1922-34 79 231 160 136 115 112 97 81 70 81 71 58 49 48 10 419 Result of Schick Test. |Pos. | Neg. | Pos. Neg Not read Pos. Neg. Pos. Neg. Not read Pos. Neg. Not read Pos. Neg. Not read Pos. Neg. Pos. Neg, Pos. Neg. Pos. Neg.. Pos. Neg. Pos. Neg. Pos. Neg.| Pos. Neg. Pos. Neg. Pos. Neg. Not ead Total for 12 years. 73 6 218 10 3 151 9 114 21 1 81 32 2 72 38 2 62 35 52 29 42 28 33 48 33 38 30 28 19 30 20 28 6 4 227 188 4 1233 Pos. 572 Neg. 12 Not read. Immunised without preliminary Schick test (Jan. 1927eud of 1935). 116 237 119 80 59 22 10 5 3 3 1 1 1 1 2 Total immunised without preliminary Schick test 660 Total immunised (includes immunisation of Schick positives as shown above). 173 396 224 167 118 78 69 62 35 33 27 27 14 16 4 190 Total immunised (includes above). 1633 51 Two cases of diphtheria occurred in immunised children during the year 1935. Since starting the work twelve cases in all have occurred, particulars of which are given in the following table: — The following table gives particulars of the twelve cases of diphtheria :— TABLE III. Diphtheria in Children Schick-Tested and Treated with Immunising Inactions. Initials Age in years at date of Schick Test Sex Type of Home Date of Schick Test First Injection Final Injection Re test Result of Re test Date of onset of Diphtheria Interval between last injection and date of onset of disease Confirmation of diagnosis by cter of Attack 1. A.C. 4 4/12 M. Artizan— moderately satis, factory; house let in lodgings 30/1/24 7/2/24 20/2/24 (Third) none — 18/3/25 13 months Metropolitan Asylums Board (N.E. Hospital) Verysevere 2. G.L. 6 5/12 M. Higher Artizan— model dwellings 4/4/23 11/4/23 25/4/23 (Third) none - 29/5/25 13 months Metropolitan Asylums Board (N.E. Hospital) Very mild 3. M.T. 3 5/12 F. Higher Artizan— model dwellings 24/9/24 1/10/24 15/10/24 (Third) none - 5/4/26 18 months Metropolitan Asylums Board (N.E. Hospital) Mild 4. L.P. 6 8/12 F. Higher Artizan— part of private house 11/11/26 17/11/26 1/12/26 (Third) none - 23/12/26 22 days* Metropolitan Asylums Board (N.W. Hospital) Severe 5. R.H. 7 M. Residential, separate private house 28/9/27 5/10/27 19/10/27 (Third) none - 21/10/27 2 days* Cuddington Isolation Hospital Mild Mild 6. P.P. 1 8/12 F. Artizan— model dwellings 5/9/23 12/9/23 26/9/23 (Third) none - 26/10/27 4 years Metropolitan Asylums Board (N.E. Hospital) Mild 7. J.F. 1 10/12 F. Higher Artizan— model dwellings 13/5/25 20/5/25 10/6/25 (Third) yes negative 11/11/25 19/2/28 2 9/12 years Metropolitan Asylums Board (N.E. Hospital) Mild attack of nasal diphtheria 8. V.C. 3 5/12 F. Poor, one room; house let in lodgings 9/4/24 30/4/24 18/6/24 (Third) yes negative 12/9/24 21/2/28 3 8/12 years Metropolitan Asylums Board (N.E. Hospital) 9. W.J. 3 3/12 F. Fair, two rooms ; house let in lodgings 12/1/27 19/1/27 9/3/27 (Third) yes negative 19/10/27 15/4/29 2 1/12 years Metropolitan Asylums Board (N.W. Hospital) Mild Mild attack of nasal, faucial and laryngeal diphtheria 10. I.S. 5 3/12 M. Higher Artizan 7/2/34 21/2/34 7/3/34 (Third) no - 9/6/34 3 months* L.C.C. Brook Hospital 11.R.B. 1 ½ M. Artizan— model dwellings none 21/11/34 5/12/34 no - 28/1/35 7 weeks* L. C C (N.W. Hospital) Mild case of faucial, nasal and laryngeal diphtheria 12. L.W. 6½ F. Artizan— model dwellings none 18/8/33 30/8/33 yes negative 20/12/33 26/7/35 2 years L.C.C. (N.E. Hospital) Mild attack of diphtheria D2 *These four cases occurred before the lapse of 9 months, the period usually laid down as required to secure artificial immunisation. 52 The above table shows that only three of the children were retested after the last injection. It cannot be assumed that immunity invariably follows the administration of three immunising injections, nor that immunity even when once established is invariably permanent. Drs. Parish and Okell have shown that of 440 Schick positive children who were rendered Schick negative by immunisation, 5 per cent. were found to be positive when re-tested 1-7 years later. Diphtheria in Children Treated with Immunising Injections. Up to the end of the year 1935 twelve cases of diphtheria occurred in children who had been treated with three immunising injections; the details of these are given in Table III. Diphtheria was also notified as having occurred in two children who had been found negative to a first Schick test, but the diagnosis was not confirmed. Diphtheria was also notified as having occurred in fifteen other children who had completed their course of inoculation, but the diagnosis in these cases was eventually not confirmed. Two of these (brother and sister) were removed to hospital as suffering from diphtheria, but they were diagnosed as suffering from rubella and "carrying" diphtheria bacilli but not suffering from diphtheria. A third child was removed with diphtheria and found to have measles. Two cases removed with diphtheria were returned as cases of coryza, not diphtheria; a sixth was removed with faucial diphtheria, but the diagnosis was not confirmed. A seventh was removed with diphtheria but was found to be a case of follicular tonsillitis. An eighth was notified as a case of nasal diphtheria, but the diagnosis was not confirmed, and the child was not removed to hospital. All these children had been found negative to the retest some time previously. Five others were removed to L.C.C. hospitals as suffering from diphtheria, but were shortly afterwards discharged as being not cases; neither had been re-Schicked since being inoculated; one case after return from hospital gave a negative reaction to the re-Schick test. The thirteenth was notified as suffering from scarlet fever and diphtheria, but was later diagnosed as suffering from scarlet fever only; the fourteenth and fifteenth, also removed to hospital as suffering from diphtheria, were returned as cases of catarrhal sore throat and not diphtheria. One adult who had been retested after immunisation was removed with diphtheria, but the diagnosis was not confirmed. One case of nasal diphtheria occurred in an adult who had been found negative to a first Schick test. Four adults who had completed their course of inoculation but had not been retested were removed to L.C.C. hospitals as suffering from diphtheria, but were returned as not diphtheria; one was suffering from follicular tonsillitis and one from tonsillitis; in one there was no evidence of clinical diphtheria, but the patient had virulent diphtheria bacilli in the throat; in the fourth the diagnosis w as not confirmed. Immunisation of Nursing Staff at the London Homoeopathic Hospital. The arrangements made in June, 1930, with the authorities of the London Homoeopathic Hospital for the Medical Officer of the Council's Immunisation Clinic to Schick test and immunise the nursing staff was continued during 1935. At this hospital Schick testing of all newcomers and immunisation of positives is now customary. 53 From June, 1930, till the end of December, 1935, 183 nurses were tested: 19 of these were tested for the first time in 1935. Seven being positive and twelve negative. Five were immunised, two probationers not remaining at the hospital. Immunisation of School Children. Attendances of London public elementary school children to be immunised against diphtheria at Municipal Centres are now allowed to count as attendances at school. Scarlet Fever. There were 50 notifications of scarlet fever. All were removed to hospital. Five of these were returned from hospital diagnosed as not suffering from this disease. From one hospital in the Borough 42 in-patients were notified as so suffering; none were resident in Holborn. There was no "return" case of scarlet fever. One notification of a " secondary " case was received. There was no death from this disease. 10,954 cases of scarlet fever were notified in London with 24 deaths. Acute Rheumatism in Children. The Holborn (Acute Rheumatism) Regulations of 1929 came into force on the 1st April, 1929 ; these require the notification of acute rheumatism in children up to the age of sixteen years. The regulations were superseded from the 1st January, 1933, by the Holborn (Acute Rheumatism) Regulations, 1932, which have been extended to the 31st December, 1938, by the Holborn (Acute Rheumatism) Regulations, 1935, dated 10th December, 1935. Acute rheumatism as defined by the Regulations means : — (i) Rheumatic pain or arthritis, if accompanied by a rise in temperature; (ii) Rheumatic chorea (St. Vitus' dance); (iii) Rheumatic carditis. Information of seventeen cases was received in 1935. Age and Sex Distribution of notified cases. Sex Age in years. ... M. F. Total. 2 ... 1 — 1 3 ... 1 — 1 4 ... 4 4 8 5 ... 2 5 7 6 ... 9 5 14 7 ... 3 6 9 8 ... 8 9 17 9 ... 8 14 22 10 ... 7 12 19 11 ... 5 6 11 12 ... 4 11 15 13 ... 4 4 8 14 ... 2 12 14 15 ... 4 4 8 Totals ... 62 92 154 54 The Holborn children attend Rheumatism Supervisory Clinics at the Hospital for Sick Children, Great Ormond Street, and at the Royal Free Hospital. Enquiries in Notified Cases of Rheumatism.. Enquiries into the housing conditions of the notified cases showed that 70 lived in satisfactory artisan self-contained flats; 28 lived in satisfactory artisan homes in divided houses of a comfortable type (a better class of house let in lodgings); 49 lived in houses let in lodgings; 8 lived in artisan dwellings of an old type, not self-contained, but superior to ordinary houses let in lodgings; and two were not traced as a result of incorrect addresses. Dampness in Houses. Dampness was found in five houses, in four of which it was due to temporary nuisances which were remedied. In the fifth case a closing order was made in respect of a damp underground room ; and the family removed from the Borough. Lighting and Ventilation. Four children lived in a semi-basement flat, and although the lighting was not good, the flat was well built and the street and courtyard adjoining fairly wide, so that lighting and ventilation compared not unfavourably with upper floors in narrow streets and small courtyards. In ten other cases the lighting was unsatisfactory, including the family referred to as living in an underground room. Most of the remaining homes were well ventilated and the lighting good; in only one case was ventilation or lighting markedly unsatisfactory. Overcrowding and Sleeping Accommodation. There was evidence of legal overcrowding in only two of the houses and steps were taken to abate this nuisance. The sleeping arrangements are given in the following table :— Sleeping Arrangements—143 Cases of Notified Rheumatism .* No. of Rheumatic Children Separate Room Separate Bed in Living Room Separate Bed in Room shared with Bed shared with Bed shared in living room with Adults Children Adults and Children Adults Children Adults and Children Children Adults and Children 1 2 3 1 2 3 2 3 4 5 1 2 3 1 2 3 1 2 1 2 3 143 12 13 8 8 0 10 8 0 4 6 2 1 10 0 0 35 13 1 1 1 2 1 1 143 12 13 53 61 4 * Exclusive of two cases where wrong addresses given, one where the patient died shortly after the date of notification, and eight where the child removed immediately after notification. Social Conditions. Seven children live in one-room homes. In sixteen homes there is a history of chronic poverty, but without acute distress; in three of these the mother has been many years widowed; in another the mother has been rearing the illegitimate family of a man who also supports bis wife and his legitimate family on a moderate income; two are living on widows pensions. In all these homes difficulty of providing proper clothing, and more especially sufficient boots, may arise at any time, and if this does occur we hope to be able to solve the difficulty. 55 Value of Notification of Rheumatism in Children. The notification of rheumatism in children enables research to be made into conditions which may possibly influence the incidence of the disease; it also calls attention to rheumatism as a disease of childhood. The periodic visiting which follows upon notification enables the health visitor to bring home to the parents the need of intensive care for the child and of giving consideration to his future welfare. Without such visiting, the poor health of the child might be accepted as inevitable and no special effort might be made to secure for him the best conditions within the reach of the parents. In Central London, where facilities for obtaining good fresh food at reasonable prices abound, the provision of a suitable diet is a matter of knowledge and means. There are, however, many difficulties in the way of providing adequate sleeping accommodation for ohildren. High rents must be paid for even few and small rooms and flats, and. thus the condition which is frequently most harmful to the child, namely, a crowded sleeping room, is the most difficult to remedy. Children are not infrequently found sleeping two or three in a bed, because there is not enough floor space to allow of another bed being put up; spare beda, which could be used if there were room for them, must sometimes be stored. A separate bed is especially desirable for a rheumatic child, but if this can be secured only by placing the bed in the living room, the child will go to bed too late and get up too early, and this may be worse for him than sharing a crowded bedroom. Where the father must either live near his work or run the risk of losing it, it is no solution of the difficulty to suggest that the family shall remove to the Greater London area. At the 6ame time, it is occasionally found that a child for whom ample and separate accommodation is provided is kept up until the parents' bedtime because the parents do not understand the vital importance to the child of sleep during the early hours of the night. Condition of the Nose and Throat. In fifty-four children the condition of the tonsils was stated to be normal. Seventy children had their tonsils removed, forty-three of these also had adenoids removed. In eleven cases tonsillectomy was advised, four of the eleven also requiring removal of adenoids. In the remaining four cases the tonsils were enlarged at the time of examination but no special treatment was recommended. Of the seventy children referred to above, in twelve cases the removal of the tonsils coincided with the reported onset of rheumatism, in that the diagnosis of the rheumatic condition was made in connection with the attendance of the children at hospital on account of tonsilitis. In thirty-four tonsillectomy had been performed at varying periods considerably before the symptoms of rheumatism were observed (from seventeen of these also adenoids had been removed) ; in twenty-one others the children were found to have had tonsils removed as part of treatment for rheumatism. Teeth. All children are reported to be under dental supervision, with treatment if required, as part of the school organisation. Contacts. Twenty-seven of the notified cases had no contacts. A history of pains in limbs was reported in the contacts of eleven cases. The names of all the other contacts going to school were passed on by the London County Council district organiser to the Divisional School Medical Officer in order that they might be observed and examined if necessary. 56 History of Patients after leaving school. During 1935 four children ceased to attend school and are occupied as follows: — (1) Boy (H. T., æt. 15) is an office boy. ' (2) Girl (V. R., æt. 14) removed. (3) Girl (P. C., æt. 14) is a shop assistant. (4) Girl (E. R., æt. 14) is a shorthand typist. Six children reached the age of 16 during 1935, and still continue their previous employment. Holidays for Rheumatic Children. An annual holiday in the country or by the sea is of benefit to all children; it is even more necessary for children who are handicapped by rheumatism. Co-operation with the school organisation was continued, and in nearly every case a holiday was arranged for each child who was physically fit for a holiday home, special arrangements being made for those attending schools for the physically defective. Typhoid and Paratyphoid Fever. Enteric Fever. Two cases were notified. In the first, a nurse at a voluntary hospital, bacteriological examination was positive for Paratyphoid C. The patient was a female, aged 19 years. The source of infection was not traced. The second case was a professional dancer. Bacteriological examination gave a Widal reaction positive to B. Typhosus; and a diagnosis of enteric fever was thus confirmed. Prior to his illness the patient had been a member of a touring company, visiting a number of provincial towns. There were 187 cases of enteric fever in London with 17 deaths. Typbus Fever. No case of typhus fever was notified during the year in the Borough or in London. Cerebro-spinal Fever. One case of Cerebro-spinal fever was notified in the Borough. One hundred and six cases were notified in London, giving rise to 69 deaths. Dysentery. Six cases of dysentery were notified. One was of the Flexner type—a chronic case of illness, originally contracted in India. The remaining five cases (two adults and three children) were of the Sonne type; and the source of infection was not traced. All were treated in hospital. One hundred and ninety-nine cases were notified in London with 24 deaths. 57 Malaria. Three cases of malaria were notified. In one the disease was contracted on the Gold Coast where the patient had been a hospital matron; in another the patient had the disease in Ceylon, from which country he had recently arrived; the third patient was a male, aged 31, who, arriving from Australia, stayed for a fortnight at a boarding house in Holborn. All three patients were treated at the Hospital for Tropical Diseases. Thirty-seven cases were notified in London, with one death. Encephalitis Lethargica. One case of encephalitis lethargica was notified in the Borough during the year. The patient, a child, aged 3 years, was notified as also suffering from whooping cough. The child was removed to a L.C.C. infectious hospital, where she was still under treatment at the end of the year. Since the Public Health (Encephalitis Lethargica) Regulations came into force on the 1st January, 1919, twenty-one cases of the disease have been brought to our notice as occurring in Holborn. In thirteen of these it is known that the disease proved fatal. At the end of 1935 four patients were still in hospital; three had left the British Isles and one was reported as completely recovered. In London fifteen cases of acute encephalitis lethargica were notified during the year 1935, and in the same period 34 deaths were registered as due to this disease. Acute Poliomyelitis and Acute Polioencephalitis. No case of these diseases was notified as occurring in the Borough during 1935. Eighty-five cases were notified in London giving rise to 15 deaths. From the coming into operation of the Poliomyelitis Order, 1912, to the end of 1935, eighteen cases were notified in the Borough. Of these, five have died; two are reported as recovered with no crippling or only a slight limp; three others as sufficiently recovered to be working, three children are at school, one patient has lost the use of his lower limbs, one is able to walk with suitable appliances, and three could not be traced at the addresses given or have been lost sight of on removal from the Borough. Pneumonia. Thirty-eight cases of pneumonia were notified during the year. Six of these were influenzal pneumonia. Seven deaths were recorded from all forms of pneumonia. 58 The 19 cases of primary pneumonia were notified at the following ages:—From 1 to 5 years, 7; from 5 to 15 years, 2; from 15 to 35 years, 1; from 35 to 45 years, 1; from 45 to 65 years, 4; and 65 years and upwards, 4. Four were treated at home; 5 were removed to L.C.C. hospitals; 10 to voluntary hospitals. Two of the. patients were nursed by the Metropolitan Nursing Association. Enquiry respecting the cases of primary pneumonia elicited the following information:— 12 resided in tenement lodging houses, 1 in self-contained flats, 4 in model dwellings, 1 in a hotel, and 1 in housekeeper's rooms of offices. The cleanliness of the houses were reported satisfactory in 10 cases, but only fairly so in 5, and in 4 cases no information was obtainable. The economic conditions of the families concerned were found to be good in 4 cases, fair in 6, poor in 4, very poor in 1; in 4 cases information as to economic condition was not obtainable. Influenza. There were 3 deaths (1 male, 2 females) from influenza, these figures being the same as in 1934, in comparison with 25 in 1933, 12 in 1932, 13 in 1931, 1, in 1930, 44 in 1929, 3 in 1928, 20 in 1927, 8 in 1926, 9 in 1925, and 11 in 1924. Anthrax. No case of anthrax was notified in the Borough during the year. Chicken-pox. This disease is not notifiable, but during the year 1935 we received information of 41 cases. These were visited and where necessary kept under observation. Mumps. Information was received from school teachers and others of 59 cases of mumps. Bacteriological Work. The following table gives details of the examinations made during the year: — Diphtheria Pulmonary Tuberculosis Other Diseases Number Submitted Result of Examination Number Submitted Result of Examination Number Submitted Result of Examination. 504 Bacilli not found 415 Diphtheria Bacilli found 89 Vincent's organisms found 7 62 Bacilli not found 54 Bacilli found 8 3 Negative 1 Bacilli found 2 Disinfections. During the year 531 rooms and 5,378 articles of bedding, clothing, etc., were disinfected after various infectious diseases, inclusive of tuberculosis. 59 Forty-seven rooms and 434 articles of bedding, clothing, etc., were disinfected on account of tuberculosis. Special attention is devoted to toys and more particularly to any toy put in the mouth. One hundred and forty-eight books and 65 toys were disinfected. The disinfections also included ten lockers, and three hospital wards. Cleansing of Persons Act. During the year 131 persons (128 men and 3 women) infested with vermin had their bodies and 1,443 articles of clothing disinfected, free of charge, at our cleansing station (Goldsmith Street). Shelter during Disinfection. For some years past an arrangement has been in operation with the Council of the Metropolitan Borough of Finsbury for accommodation to be provided at their Reception House, Northampton Road, for residents of this Borough during the disinfection of their homes after infectious disease. In the year 1935 the accommodation was used by eight Holborn families comprising 41 persons (12 adults and 29 children). Extermination of Vermin. One hundred and seventy-three verminous rooms were disinfested by the Council's staff. In dealing with verminous rooms, the fumigation is repeated, whenever practicable, at the end of twelve to sixteen days, by which time it is expected that any eggs of bugs will have hatched out; a single fumigation of any severely infested room cannot be regarded as satisfactory. In 130 cases last year this second fumigation was carried out. When this course was for any reason impracticable, the occupiers of the rooms were advised to use a disinfecting spray, and to take such other measures as appeared likely to prevent recurrence of the infestation. Cancer. During the year 1935, 58 deaths were recorded as due to Cancer in comparison with 52 in the previous year. The deaths in 1935 were equal to a rate of 1.64 per thousand, the corresponding rate in 1934 being 1.44 per thousand. It will be seen that the death rate from Cancer in the Borough in 1935 was 0'20 per thousand higher than in the previous year. The rate, however, for one year in districts of comparatively small populations does not furnish a reliable indication of the prevalence of a particular disease. The decennial rates, which afford much more reliable indication of the seriousness of Cancer, show that in the past 20 years there has apparently been a marked increase in the death rate from this disease, tor while the decennial average for the ten years, 1916-1925 was 1.37 the corresponding rate for the ten years, 1926-1935 was 1.67. Some part of this increase may reasonably be attributed to improved facilities for diagnosis, and can also be correlated with the age-distribution of the population. 60 Tuberculosis. Summary of Notifications and Deaths. The following table gives the number of new cases of tuberculosis and deaths from the disease in the Borough during 1935 in the form required by the Ministry of Health: — Age periods. New Cases. Deaths. Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. M F M F M F M F 0 - - - - - - - - 1 - - - - - - - - 5 1 - 1 1 - - - 1 10 2 3 1 - 1 - - - 15 1 - - - - - - - 20 7 6 - - 2 1 - - 25 8 10 1 - 2 1 - - 35 5 8 - - 2 3 - - 45 7 - 1 - 7 - - - 55 3 - - - 8 - 1 - 65 6 1 - - 8 1 - - 40 28 4 1 30 6 1 1 Total number of cases on the Register of Tuberculosis in the Borough on the 31st December, 1935 326 Number of these patients residing in common lodging houses 36 The average number of cases notified annually during the past ten years 87 The number notified in the year 1935 73 Of the 73 cases notified in 1935 the number who attended the Dispensary 26 Total number of new cases examined at the Dispensary for the first time in 1935, including the above, and all contacts 94 Total attendances at the Dispensary in 1935 673 Supervision of home conditions; visits paid by— Tuberculosis Officer 61 Dispensary Nurse 991 61 Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications during the period from the 1st January, 1935, to the 31st December, 1935, in the Metropolitan Borough of Holborn. Age-periods. Formal Notifications. Number of Primary Notifications of new cases of Tuberculosis. Total Notifications. 0- l- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages). Pulmonary Males - - 1 2 1 0 7 4 7 3 4 35 40 ,, Females - - - 2 - 5 7 6 - - 1 21 25 Non-pulmonary Males - - - 1 - - 1 - - - - 2 2 ,, Females - - - - - - - - - - - - - Supplemental Return. New cases of tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification:— Age-periods. 0— l— 5- 10— 15— 20— 25— 35— 45 — 55— 65— Total. Pulmonary Males - - - - - 1 1 1 - 2 - 5 „ Females - - - 1 - 1 3 2 - - - 7 Non-pulmonary Male - - - 1 - - - - 1 - - 2 „ Females - - 1 - - - - - - - - 1 62 The source or sources from which information as to the above-mentioned cases was obtained are stated below: — Source of Information No. of Cases. Pulmonary Non-Pulmonary Death Returns From local Registrars Transferable deaths from Registrar General 1 - Posthumous notifications 1 1 " Transfers" from other areas (other than transferable deaths) 10 2 Other Sources if any (specify) - - Notification Register. Pulmonary Non-pulmonary Total Cases Males Females Total Males Females Total Number of cases of Tuberculosis remaining at the 31st December 1935, on the Registers of Notifications 171 97 268 33 25 58 3.26 Number of cases removed from the Registers during the year by reason inter alia of :— Withdrawal of notification - 1 1 - - - 1 Recovery from the disease - 1 1 1 1 2 Death 30 6 36 1 1 2 38 Tuberculosis Notifications. Excluding duplicates the total number of notifications received on Form A or B during the year 1935 was 58, 15 other cases were brought to my knowledge (making 73 new cases in the year). These were:—Private cases 11, hospital cases 41, Public Assistance cases 8, from death returns 1, transfer from other districts 12. Of the 73 cases entered on the Register in 1935, 68 were pulmonary tuberculosis and 5 non-pulmonary tuberculosis. Fifty-five of the cases were removed for treatment to hospitals, sanatoria, &c. Sleeping Conditions. In 55 of the 73 new cases of tuberculosis in 1935 it was possible to obtain information as to the sleeping conditions at the date of notification. 63 The following is a summary of the information in the 55 cases above referred to : — Patient slept in— Separate bed room 13 Separate bed in living room 11 Separate bed in room shared with— 1 adult 11 2 adults 2 3 adults 3 2 children 1 - 41 Shared bed with— No others in room 1 adult (Husband or Wife) 7 1 adult (not Husband or Wife) 2 Shared bed with— 1 adult Other persons in bedroom 1 child 3 2 children 1 3 children 1 - 14 55 Classification of Homes. The classification of homes as suggested by the London County Council has been reported on as far as practicable with the following results: — "A."—Good environment, clean, well-kept, separate bedroom (or in the case of husband and wife, no other occupant of bedroom), good food and clothing 10 " B."—Fair. Separate bed, but not separate bedroom 41 " C."—Bad. Dirty environment, dirty ill-kept home, no separate bed, bad management as to food and clothing 7 58 Non-attendance at Tuberculosis Dispensary. Twenty-six of the 73 cases attended the Holborn Tuberculosis Dispensary. 64 The following indicates the reasons for non-attendance in the remaining cases: — Removed to Hospitals, etc., for treatment without prior attendance at Dispensary 14 Dead before or soon after notification 8 Treatment at home by private doctor 3 Not traced and common lodging house cases 7 Removed from Borough 11 No information 4 47 Institutional Treatment. During the year notifications were received of 86 admissions to institutions. These admissions represent 75 patients, some of whom are transferred from one institution to another, and others are discharged, or take their own discharge, and subsequently are re-admitted. The admissions were to the following institutions: — Institutions of the London County Council 64 Other institutions 22 Visits to Homes, etc. During 1935 the Tuberculosis Officer made 61 visits to the homes of patients. The general visitation of the patients and supervision of home conditions is carried out by the Tuberculosis Nurse who made 991 visits. The advice given by the Tuberculosis Nurse includes suggestions respecting food and cooking and suitable cookery books are supplied free of charge. Contacts. All contacts are urged to attend for examination at the Tuberculosis Dispensary. Fifty-nine contacts, viz., 31 adults and 28 children under fifteen years of age, were examined for the first time during the year 1935. Of these, four adults and two children were found to be definitely suffering from tuberculosis. Fiftythree were definitely diagnosed as not suffering from the disease. The routine examination of contacts is desirable as a means of discovering not only cases of tuberculosis in early stages of infection but even definitely infective cases which may be disseminating infection although remaining undiscovered and untreated. Arrangements were continued during the year for co-operation with the school medical service to ensure that no contacts of school age remain unexamined; if such examination cannot be carried out at the Dispensary the School Medical Officers are notified so that the examination may be carried out at the school. Information as to the results of such examinations, whether at the Dispensary or the schools, is interchanged as necessary. 65 Tuberculosis Dispensary. The following is the Report of the Tuberculosis Officer, J. A. Struthers, M.D., B.Ch., M.R.C.P., D.P.H., for the year 1935 :— Return showing the work of the Dispensary during the year 1935. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 20 10 3 - 1 - 2 - 21 10 5 - (b) Doubtfully tuberculous 1 - - - - - - - 1 - - - (c) Non-tuberculous - - - - - - - - 3 5 1 - B.—Contacts examined during the year:— (a) Definitely tuberculous 1 3 - 2 - - - - 1 3 - 2 (b) Doubtfully tuberculous - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 11 16 18 8 C.—Cases written off the Dispensary Register as (a) Recovered - - - - - - - 2 - - - 2 (b) Non-tuberculous (including any such cases previously diagnosed and entered in the Dispensary Register as tuberculosis) - - - - - - - - 14 21 19 8 D.—Number of Persons on Dispensary Register on December 31st:— (a) Definitely tuberculous 98 63 7 9 12 16 10 11 110 79 17 20 (b) Diagnosis not completed - - - - - - - - 1 - - - e 66 1. Number of persons on Dispensary Register on January 1st, 1935 232 7. Number of consultations with medical practitioners :— (a) Personal 21 (b) Otherwise 89 2. Number of patients transferred from other areas and cases returned after discharge under Head 3 in previous years 0 8. Number of other visits by Tuberculosis Officers to Homes 61 3. Number of patients transferred to other areas, cases not desiring further assistance under the scheme and cases "lost sight of" 27 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 991 10. Number of (a) Specimens of sputum, &c., examined ... 109 4. Cases written off during the year as dead (all causes) 19 (b) X-ray examinations made in connection with Dispensary work... 43 5. Number of attendances at the Dispensary (including contacts) 673 11. Number of "Recovered" Cases restored to Dispensary Register in A (a) and A (b) 0 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 79 12. Number of "T.B. plus" cases on Dispensary Register 31st December, 1935 118 67 Deaths of Tuberculous Persons. Showing the number of Patients who died in their own homes and the number who died away from home in Hospitals or other Institutions. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- All Ages Males. Females Total. Number of patients who died at home - - 1 - - - - - - 1 2 2 2 4 Number of patients who died in hospitals, etc. - - - 1 - 3 3 5 7 8 7 29 5 34 - - 1 1 - 3 3 5 7 9 9 31 7 38 Holborn Tuberculosis Care Committee. Report for 1935. The Committee has met seven times during the year. The average attendance of members at each meeting has been 10.4. In May, 1935, it was decided that, in future, the Committee should meet once in three months instead of monthly as heretofore. Fifty-eight cases have come before the Committee for consideration during the year. Of these, 29 were new cases (25 adults and four children), and 29 were old cases (26 adults and three children). Thirty-four adults and seven children were admitted to Institutions for treatment. Nine children were sent away under the Contact Scheme. Voluntary contributions towards the cost of treatment and maintenance, amounting to £39. 10s. 0d., were collected for the L.C.C. from two cases. Twelve Progress Reports, on seven children, were received from the L.C.C., and the information contained therein was conveyed to the relatives. One child was admitted to the Open Air School. Two children were sent away for convalescence through the Invalid Children's Aid Association, and one through Stafford's Charity. Convalescence was also arranged for one adult through Stafford's Charity, but was postponed for domestic reasons. Holidays were arranged for three adults and one child. Ten patients were advised and assisted with National Health Insurance difficulties. In July, 1934, the London County Council decided that treatment for Tuberculosis should be provided free of cost to patients in their area. During 1935 further concessions were made. The L.C.C. has now decided to pay the travelling expenses of children who are sent away under their Contact Scheme, E2 68 and, in necessitous cases, the fares of patients proceeding to Hospitals in, and around, London. It has also been decided that, in future, no contributions shall be asked from patients, or from persons legally responsible for them, towards the cost of dentures or spectacles provided by that Council to patients during the course of their treatment, other than the amounts that are due to patients from National Health Insurance or any Benefit Society to which the patients are contributors. Ordinarily, patients are expected to provide their own clothing, but, in cases where there is difficulty in doing so, the L.C.C. decided that, as from the 1st October, 1935, clothing which is certified by the Medical Officer of Health as necessary to enable a patient satisfactorily to undergo residential treatment for tuberculosis, and which cannot be obtained in any other way, shall be supplied by that Council under its Tuberculosis Scheme through its Supplies Department. Six applications for clothing for patients undergoing treatment were made to the L.C.C., two patients were supplied with clothing by the British Legion and United Services Fund Benevolent Department, and in three other cases clothing was supplied by the Emergency Help Fund of the British Bed Cross Society, the Personal Service League, and the Welsh Girls' Friendly Aid Society respectively. Other assistance has been afforded to our families by the British Legion and United Services Fund Benevolent Department, the Charity Organisation Society, and the Society for the Relief of Distress. We also gratefully acknowledge the gift of 34 coal tickets from the London Philanthropic Society, and further coal and milk tickets given to us by Councillor Wheatley. To all Societies and Organisations that have co-operated with the Committee for the benefit of our tuberculous families we tender our sincere thanks. Through the generosity of a number of contributors, including several members of the Borough Council, the Committee was able to obtain nominations for Christmas Dinners for 42 families through the Polytechnic Distress and Christmas Dinner Fund, and to make gifts of coal to 20 families at Christmas time. We can assure all those who assisted us that their gifts were very much appreciated. During the year 764 visits have been paid to patients or their families, and over 100 visits were paid to Hospitals, Societies, Offices, and individuals in connection with the needs of patients. Twenty-nine patients, or families, known to the Committee have left the Borough during the year; five of these were transferred to other Care Committees. Eight cases were transferred to the Borough from other districts. Six applications were forwarded to the London County Council for better housing accommodation. Owing to their financial circumstances and the conditions of their employment these families could not leave Central London. All are still awaiting the accommodation they need. Twenty-one patients known to the Committee have died during the year. Three died at home, and 18 died in Institutions. Early in the year the Committee became affiliated to the National Association for the Prevention of Tuberculosis, and the Hon. Secretary attended the 69 tion's Conference at Southport in June as delegate of the Committee. Representatives of the Committee also attended the meetings of the Standing Conference of Metropolitan Borough Tuberculosis Care Committees which were held at County Hall on January 26th, June 13th and November 22nd. Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not necessary to take any action under the above Regulations during the year 1935. Home Nursing for Tuberculous Patients. It was not necessary during the year 1935 for any tuberculous patient to be nursed under the arrangements made by the Council with the Metropolitan District Nursing Association. Dental Clinic for Tuberculous Persons. Arrangements were continued for tuberculous persons referred from the Tuberculosis Dispensary to receive dental treatment as part of the Council's Tuberculosis Dispensary Scheme, at the Clinic of the British Dental Hospital, No. 10, John Street, W.C. Particulars of this service are given in the table below (General Dental Clinic). The Clinic is held by the British Dental Hospital at the Council's Maternity Centre, 10, John Street, on Tuesday evenings. General Dental Clinic. By arrangement with the British Dental Hospital, a Dental Clinic open for inhabitants and workers in the neighbourhood is held on Tuesday evenings at the Council's Maternity and Child Welfare Centre, No. 10, John Street. Tuberculous patients are also seen at the Tuesday evening Clinic by appointment at times outside the hours for the general public. The Secretary of the Hospital has kindly supplied the following information of the work at the Clinic during the year 1935: — Summary of Work carried out at Dental Clinic, 10, John Street, Holborn, on Tuesday Evenings, during 1935. Number of sessions held Tuberculosis Patients. All Patients. 49 Number of patients' attendances 4 267 Number of fillings 3 55 Number of scalings 1 10 Number of extraction cases Without anaesthetic - - With local anaesthetic - 37 With gas - 12 Number of teeth extracted - 144 Number of dentures (including repairs) - 24 Number of dressings - 17 Number for advice 1 51 Number of denture visits - 54 Number of new patients - 50 70 MATERNITY AND CHILD WELFARE. Notification of Births. During the year 136 births were registered as occurring in the Borough. During the same period 123 notifications of births occurring in the Borough were received. Of these, 122 were from doctors and midwives, 1 from parents. The mothers were attended at their confinement by:— Private Doctors 10 Private Midwives 9 Out-patient Midwifery Departments of General Hospitals and Institutions:— Extems and others 13 Midwives.—University College Hospital 24 Middlesex Hospital 11 Other Institutions 28 Training Institution for Midwives, Myddelton Square 27 122 Three of these notifications related to stillbirths. Number of Births. The number of births transferred to the Borough from outlying institutions was 144 The number of births transferred from the Borough to other districts was 7 The net number of births belonging to the Borough was 271 There are no maternity hospitals or lying-in institutions in the Borough, but maternity cases are admitted to a nursing home in the area. Births in Crowded Homes. The following table is an indication of the home conditions of 219 mothers in relation to their confinement:— Living in:— Confined at home. Confined in hospital. No. Percentage of Total Births. No. Percentage of Total Births. One roomed homes 9 3'3 22 8'1 Two „ „ 52 19'2 60 22'1 Three „ „ 25 9' 2 27 10'0 Four or more „ 15 6'5 9 3'3 Total 101 37'2 118 43'5 These figures show that many of the women are confined under very uncomfortable and unfavourable circumstances. 71 Home Visiting. The visits paid to the homes by the Health Visitors during the year were as follows:— First Visits. Revisits. Total. Expectant Mothers 142 319 461 Post-natal Mothers 2 6 8 Children under 1 year of age 272 588 860 Children 1 to 2 years of age 29 321 350 Children over 2 years of age 41 738 779 Enquiries re stillbirths 9 „ re ophthalmia neonatorum 4 Other visits 228 Two hundred and eighty-one visits related to infants who carne under further observation in their own homes or at Infant Welfare Centres; of this number 178 were recorded as attending a Centre, i.e., 63 per cent. Thus nearly five-sixths of those visited attended an Infant Welfare Centre and of these 86 per cent, attended the Council's Centres. Attendances at Infant Welfare Centres. The Centres attended were the following:— 122 attended the Council's M. & C. W. Centre at 10, John Street. 24 „ „ „ „ Short's Gardens. 4 attended the Centre at Charing Cross Hospital. 2 „ „ Myddelton Square. 10 „ „ Middlesex Hospital. 4 „ „ University College Hospital. 6 „ „ Royal Free Hospital. 6 „ „ other Centres. 178 attended an Infant Welfare Centre. Work at Centres. Holborn Centre, 10, John Street. The following is an analysis of the attendance at this Municipal Centre: Monday. Tuesday. Wednesday. Thursday. Friday. Medical Consultation Pre-School child 2—4.30 p.m. Antenatal and Postnatal cases 2—4.30 p.m. Medical Consultation 2—4.30 p.m. Class 3—4 p.m. Dentist. 2—4 p.m. Medical Consul tation 2—4.30 p.m. No. of Sessions 48 53 51 32 61 49 Total attendances- Children 613 ... 1480 ... 62 1300 Mothers 11 181 282 429 201 233 Average weekly attendances— Children 12 ... 29 ... 1 26 Mothers ... 3 6 13 3 4 72 St. Giles' Centre, Short's Gardens. The attendances at this Branch Centre during the year 1935 were as follows:— Thursday—Medical Consultation—2—4.30 p.m. No. of Sessions 51 Total attendances—Children 401 Mothers 50 Expectant Mothers 11 Average weekly attendances 9 The total number of attendances made by the Health Visitors at the Municipal Centres in 1935 was 366, and in addition Health Visitor students made 116 attendances at the Municipal Centres. At the Holborn Centre, No. 10, John Street, 4,347 attendances were made by 395 mothers and expectant mothers; and 476 children, of whom 209 were under one year, 93 between one and two years old, and 174 aged 2-5 years on the date of their first attendance. At the St. Giles' Centre, Short's Gardens, 462 attendances were made by 27 mothers and 62 children, of whom 35 were under one year, 5 from one to two years and 22 between two and five years. Ante-natal Hygiene. Under the scheme for the voluntary notification of pregnancy which came into force in January, 1928, 61 voluntary notifications were received during 1935 as compared with 56 in 1934. All these expectant mothers, as well as those already known to the Health Visitors through other sources, were visited in their homes and informed, both verbally and by means of a leaflet, of the special facilities available in Holborn; they also received instruction in the hygiene of pregnancy, and if not already in attendance at an ante-natal centre they were advised to attend. Confinement in Institutions in Relation to Housing Conditions. Expectant mothers whose home circumstances make confinement at home especially undesirable are advised to enter hospital for confinement. In order to provide accommodation for those who are willing to take this advice an arrangement has been made with one of the principal Maternity Hospitals within reach of Holborn to accept normal cases on social grounds only. Special records have been kept of the home conditions of 143 expectant mothers visited during 1935, each case being followed up either to a succssful "issue or until it became clear that the woman would not enter hospital. Of the 86 who went into hospital: — 10 (7 primigravidæ) lived in a one-room home; 76 (30 primigravidæ) lived in a two or more roomed home. Of the 57 who remained at home: — 3 (2 primigravidæ) lived in a one-roomed home; 27 (3 primigravidæ) lived in two rooms; 27 (2 primigravidæ) lived in three or more rooms. 73 Baths. The baths provided at the John Street Centre for expectant and nursing mothers were used 123 times during the year 1935. Ante-natal Centres. During the year, enquiries were made of mothers as to their attendance at ar Ante-natal Centre immediately previous to the birth of the child visited. Of 299 mothers, about whom information was obtained, 220 (74 per cent.) were found to have attended Ante-natal Centres or received ante-natal care as under:— Number of enquiries made 299 Centre Attended: — Holborn Centre, 10, John Street 19 Holborn Centre, Short's Gardens — Royal Free Hospital 12 Middlesex Hospital 19 Charing Cross Hospital 19 University College Hospital 44 Myddelton Square Institution 28 St. Bartholomew's Hospital 21 City of London Hospital 20 Queen Charlotte's Hospital 2 Elizabeth Garrett Anderson Hospital 3 St. Pancras Hospital 17 Other Centres 10 Ante-natal care from private doctors 1 Ante-natal care from midwives 5 220 Nature of defects found at Municipal Centres. 10, John Street, Holborn. Short's Gardens St. Giles. No. of women attending ante-natal clinics 65 5 Women expectant for the first time 15 2 No. of attendances made 130 11 Defects found specially connected with pregnancy:— Deformed pelvis 2 — Threatened miscarriage 2 — Retroverted gravid uterus 1 Breech presentation — Excessive vomiting 5 Œdema 3 Varicose veins 6 1 Excessive vaginal discharge - High blood pressure 2 - Other defects 3 Other defects:— Heart disease 2 Anaemia 6 - Respiratory diseases 3 - Constipation 24 Dental caries 21 1 Dyspepsia 6 - Pyorrhœa 3 - Rheumatism 1 - Other defects 7 — No. referred to maternity hospitals:— Normal 7 1 Abnormal 4 - No. referred to dental clinic 12 1 No of urine tests made 71 - 74 Post-natal Consultations. Twenty-two attended the post-natal consultations at the Centre, 10, John Street. They made 40 attendances in all. The conditions found included one case of cancer, one case of prolapse of uterus, two cases of fibroids—all referred to hospital. Six cases of menorrhagia, two cases of retroverted uterus, two cases of leucorrhœa and cervicitis, all treated at Centre; a case of inguinal hernia for which a truss was ordered. Instruction in Mothercraft and Hygiene. For some years, both in the home and in the Centres, use has been made of leaflets written in non-technical language dealing with the hygiene of infancy and maternity and the walls of the Centres have been hung with instructive posters to give point to the teaching and to draw attention to the series of leaflets. Propaganda posters are pasted on the outer walls at the Centres. There is also a glass-fronted case for the display of a special poster; this poster is changed frequently. Mrs. Reynolds Bray, a qualified masseuse, has given valuable help by placing her services at the disposal of the Medical Officers of the John Street Centre, free of all fees. Miss Mary Carter and Miss Edith Joyce have continued to give us a great deal of valuable assistance during the year by making children's garments for busy mothers from materials supplied by the mothers and from their own resources. Miss Audrey Stables has also given assistance at the Centre on Wednesdays whenever required. Assistance is given at the Centres in cutting out garments at any time; patterns of the most suitable woven garments are given away, also directions for making knitted garments and advice as to the choice of suitable materials. A sewing machine is available for use of the mothers at 10, John Street and instruction in its use is given at any time. Up-to-date model garments for babies and young children are always on view at the Centres. Three hundred and forty hanks of wool of a special quality were sold at cost price to the value of £14. 3s. ll½d. Maternity outfits are placed on sale at the Centre at cost price, 5s. 10d. Only two outfits were sold. It is to be regretted that the price of these puts them beyond the reach of the poorest, who are often the least well equipped, and therefore most in need of the outfit. Maternal and Infant Consultations The following summary refers to maternal and infant consultations at 10 John Street and Short's Gardens Centres during the year 1935:— Reasons for attendance. 10, John Street. Short's Gardens Mothers: — Difficulty with breast feeding 14 1 Disorders of generative organs 16 — Constipation 24 — Heart disease 2 — Anæmia 21 1 Respiratory disease 7 Digestive disorders 6 — Debility 22 2 Dental caries 23 — Rheumatism 9 — Venereal Disease 2 - Other Diseases 34 3 75 Children:— (Healthy) 141 35 Alimentary disorders 34 6 Rickets 20 2 Heart disease 2 — Rheumatism 3 — Respiratory disorders 63 4 Marasmus 4 — Debility 5 — Hernia, umbilical 11 — Hernia, inguinal 2 — Phimosis 14 — Disease of skin 37 2 Disease of eye 23 — Disease of ear 10 Disease of nose and throat 32 - Dental caries 25 Other diseases 48 5 (In this table, if the patient has more than one ailment, only the more important has been recorded.) Mothers and children attending the Municipal Centres during 1935 were referred to other departments or organisations as follows:— Mothers. Children. Ante-natal Clinic 13 — Tuberculosis Dispensary — — Minor Ailments Clinic 35 110 Dental Clinic 30 25 Metropolitan Nursing Association 2 1 Nursery School Massage Clinic 6 6 Hospitals 17 35 Convalescent Homes 5 13 Assistance Sub-Committee (for milk) 29 33 Private Doctor - ] Public Vaccinator 7 Breast Massage. The following summary gives particulars of mothers referred for breast massage in 1935:— John Street. Short's Gardens Number referred to Metropolitan Nursing Association Results :— 7 2 Breast secretion re-established 2 1 Small bottle feeds required in addition to breast feeding 1 1 Massage unsuccessful 4 — Pre-school Children. During the year 1935 , 51 of the children who attended the Pre-school Clinic on Monday afternoons were found to be under normal weight and height for their respective ages and types, while 41 were over weight and height. The rest were about normal. The alimentary disorders suffered by the children consisted of constipation in 13 cases, diarrhœa in 3, one of which was a case of diarrhœa and vomiting, and threadworms in 8, while there was 1 case each of cœliac disease and mucous colitis, both of which children are undergoing hospital treatment. Two cases of umbilical bernia were treated by strapping and are improving. Seven children suffered from impetigo, 5 from lichen urticatus, 4 from eczema, while 2 had warts. There were 5 cases of boils and 2 were infested by pediculus capitis. 76 Eye diseases treated included 3 cases of conjunctivitis, 2 of blepharitis, 3 of styes, while 2 cases of strabismus and 2 of blocked lachrymal duct are undergoing treatment at hospital. Of the ear, nose and throat disorders, 5 children had discharging ears and were referred to the Minor Ailment Clinic, while there were 4 cases of tonsillitis, 4 of enlarged tonsils. 2 of adenoids and 17 of enlarged tonsils and adenoids, 15 of whom were operated on with resulting benefit to the general health. Eight children had enlarged cervical glands due in most cases to dental caries. Twenty-eight children were referred to the Dental Clinic for treatment. During the winter months there were 31 cases of nasal catarrh and bronchitis, 3 of tracheitis and 1 of nasal diphtheria which was referred to a Fever Hospital. Four children were found to be debilitated, 3 suffered from anaemia and 2 from rickets. Four were referred to the Institute of Ray Therapy and have improved in health. There were 5 cases of enuresis, and 1 of phimosis; 1 of night terrors and 1 of nail biting. They all received treatment and 3 were referred to the Institute of Medical Psychology. One child suffering from rheumatism is undergoing hospital treatment. Foundling Site Day Nursery. The establishment of a day nursery and play centre for children at the Foundling Hospital Site has been referred to in previous Annual Reports. These activities were maintained during 1935. The number of children from Holborn attending this day nursery is evidence of the need of such facilities in its immediate neighbourhood, and the Council decided again to make a contribution (£50) towards the cost incurred in connection with Holborn children. School Entrants. During the year information was received from the London County Council that 133 children living in Holborn had been entered as attending school for the first time. Particulars of the child's pre-school physical history and his record of attendance at an Infant Welfare Centre were forwarded to the head teacher of the infants department of the school concerned. This information is set out on a form supplied by the London County Council and is intended for the use of the School Medical Officer when examining school entrants. Notice of attendance at school has brought to our knowledge families hitherto unknown to us, having recently entered the Borough. This knowledge has been very useful in connection with Maternity and Child Welfare Work generally. Stillbirths. During 1935 twelve stillbirths were registered, ten of which were legitimate. Enquiry as to possible causes was made in nine cases. Three cases were not traced. In seven instances the confinement took place in hospital, two in the extern practice of an institution. Difficult labour was responsible for three; in one of these there was abnormal presentation (breech), the others were twins. In three cases there was a history of toxæmia of pregnancy, in one case no definite reason could be assigned and in two no information was obtainable. 77 Illegitimate Children. The births of 42 illegitimate children were registered. Two lived with both their parents who had a permanent home together; four with their mothers who worked to support them; three with their mothers who remained in their parents' home; three were placed in an institution; two died in early infancy; one was stillborn; four were adopted; 21 children could not be traced, the mother often not having stayed at the address given for more than one or two nights before the birth of the child. Dental Treatment. The following is a summary of the work during 1935 at the Council's Dental Clinic, No. 10, John Street, open on Thursday afternoons for nursing or expectant mothers, and children under five years of age:— Women. Children. Total Number of sessions held 51 51 51 Number of new Patients 26 31 57 Total attendances 210 63 273 Extractions— With local anaesthetic 18 (23) — 18 (23) With general anaesthetic 25 (102) 25 (84) 50 (186) Scaling 23 2 25 Fillings— Simple 60 8 68 Root — — — Dentures (including repairs) 25 — 25 Advice 50 32 82 The figures in brackets relate to the number of teeth extracted In three cases where the patients were very poor the dentures were provided free of charge; contributions towards the cost were required in all other cases and in two instances the patients were required to pay the whole cost. Supply of Milk and Food for Expectant and Nursing Mothers and for Infants. The supply of milk and food at less than cost price was continued during the year under the Maternity and Child Welfare Act, 1918, for nursing mothers, expectant mothers in the last three months of pregnancy, children up to three years of age and, exceptionally, to children between three and five years of age. During the year 306 applicants received free or assisted milk under the scheme. This number included 196 who were receiving such assistance at the end of 1934. Grants were made to 110 new applicants. At the end of the year 1935, 163 applicants were receiving assistance, viz.:— Mothers. Children. Total. Free milk 73 S3 156 Half-price milk 2 3 5 Prepared milk — 2 2 75 88 163 78 The following table shows in detail how the 110 new applicants were assisted in 1935 :— Milk. Prepared Milk. Free. Part Cost. Free. Part Cost. Expectant mothers 30 1 - Nursing mothers 16 - Children 52 5 2 4 Home Help. The Council's Home Helps attended 16 cases during the year, the same number as in the year 1934. All applications for the services of the Home Help are considered by the Assistance Sub-Committee of the Maternity and Child Welfare Committee. In three cases of extreme necessity the services of the Home Help were granted free. In all other cases the applicants were required to contribute towards the cost, contributions ranging from 2s. 6d. per week up to the full cost. The services of the Home Help have been much appreciated; and it has been found that the Council's provision meets a much felt want in the Borough. Convalescent Homes. Four mothers and their babies were sent away. In three cases the applicant was required to contribute towards the cost. Fifteen applications were granted for convalescent home accommodation for children under five years of age; in two cases the parents failed to take advantage of the facilities provided. Thirteen children were sent away, 8 free, the parents of the other children were required to pay part of the cost. All these children were admitted to the Hopedene Convalescent Home at Barnet. It is with very great regret that I have to record the death, during the year, of Sister Hope, of the West London Mission, Kingsway, who had been in charge of Hopedene from the start. Many scores of Holborn children came under her care there; and many hundreds more at the Kingsway Creche, where she worked for over forty years. Saffron Hill Maternity and Child Welfare Centre. Consultations in connection with this Voluntary Centre are held at the St. Winifred Club, St. Peter's School, Onslow Street, Saffron Hill. During the year ended 31st December, 1935, 186 children under five attended the consultations, 40 of the total number coming from the Holborn Borough. The 189 children made 2,540 attendances. Extra food and nourishment were provided, also convalescent treatment at country and seaside Homes (44 mothers and 71 children); classes and lectures on health, care of the home, food, household economy and kindred subjects were held. The Chairman and Honorary Secretary is Miss Mary Canney, 75, Lamb's Conduit Street. 79 Deaths of Infants under One Year of Age, 1935. The homes were visited in a large proportion of the infant deaths, and any requisite information obtained, and when required, suitable advice given. The causes of and ages at death are given in the following Table:— Cause of Death Under 1 Week 1-2 Weeks 2-3 Weeks 3-4 Weeks Total under 4 Weeks 4 Weeks and under 3 Months 3-6 Months 6-9 Months 9-12Months Total under 1 Year M F M F M F M F M F Both sexes M F M F M F M F M F Both sexes Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... ... ... 2 3 ... ... ... ... 1 3 3 6 Other Respiratory Diseases ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... 1 ... 1 Diarrhoea, etc. ... ...... ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... 4 ... 4 Congenital Debility, Premature Birth, etc, 7 3 ... ... ... ... 1 ... 8 3 11 ... ... ... ... ... ... ... ... 8 3 11 Violence ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 1 Totals 7 4 ... ... ... ... 2 ... 9 4 13 2 2 6 ... ... ... ... 1 17 7 24 Total both sexes 11 ... ... 2 13 4 6 ... 1 24 Net births registered during the calendar year. Males Females Both sexes Legitimate Infants 125 104 229 Illegitimate Infanta 20 22 42 Net deaths registered during the calendar year. Males Females Both sexes Legitimate Infants 12 6 18 Illegitimate Infants 6 1 6 80 INFECTIOUS DISEASES AMONG MOTHERS AND CHILDREN. Puerperal Fever and Puerperal Pyrexia. No. Initials Date of Notification Primipara or Multipara Ante-natal Care Delivery occurred in Onset subsequent to Results Remarks Patient's Homo Institution PUERPERAL FEVER—Five Cases. 1 E. G. 1-4-35 Multipara No Home - Retained placenta abortion Infected uterus septicaemia Recovered Removed to hospital ten days after abortion 2 F. S. 10-5-35 Multipara No Home - Septic incomplete abortion Recovered Removed to hospital two days after confinement 3 G. M. 29-6-35 Primipara No Home - Septic abortion Recovered Removed to hospital two days after abortion *4 S. W. 12-10-35 Multipara No Home - Septic miscarriage Unknown cause Inquest Died Removed to hospital on same day as occurrence of abortion 5 E. T. 19-11-35 Primipara Yes - Institution Retained chorion Mild endometritis Recovered - PUERPERAL PYREXIA—Three Cases. 1 J. S. 26-5-35 Primipara Yes - Institution Urinary infection Local uterine infection Recovered S. J. 6-8-35 Primipara Yes - Institution - Recovered - C. E. 24-12-35 Multipara Yes Home - Pneumonia Recovered Removed to hospital eleven days after confinement * Subsequently diagnosed as Puerperal Pyrexia. 81 Ophthalmia Neonatorum. During the year four cases of ophthalmia neonatorum were brought to our notice all notified in pursuance of the Public Health (Ophthalmia Neonatorum) Regulations, 1926 and 1928; all the notifications were from the Medical Officers of hospitals. Four Cases Notified in Accordance with the Public Health (Ophthalmia Neonatorum) Regulations. Birth Notified by. Midwife Extern Department, Hospital Extern Department, Hospital Not notified Result. Removed, Apparently cured Removed Cured Removed Medical Attendance and Nursing. Private Doctor and Nurse In-patient, St. Margaret's Hospital Doctor (Home) and Outpatient, Westminster Ophthalmic Hospital Maternity Ward—Hos. and In-patient, St. Margaret's Hospital Where Treated At home Hospital At home Hospital Type of Disease on Health Visitor's first call. Moderate Not seen Moderate Not seen By whom Notified. Doctor Doctor Doctor (Hospital) Doctor (Hospital) Age at Onset. 16 days No information 5 days 1 day Age when Notified. 20 days 6 weeks 18 days 7 days Case Number. 1 2 3 4 Y 82 Midwives Act, 1902 and 1918. In connection with these Acts we received information from the Medical Officer of Health of the London County Council, of slight inflammation in the eyes of eight other infants, all of whom made complete recovery. Whooping Cough. Visits were paid to 126 persons suffering from whooping cough. Of these, 88 were notified by doctors; in 20 others the information was derived from the schools, in nine from health visitors, in six from the L.C.C., and three from parents. Age. Fourteen were children under 1 year, 64 were aged 1 to 5 years, 48 were 5 to 16 years. Spread of Infection in Family. The 126 cases occurred in 105 families. In 87 families 1 case occurred; in 15 families 2 cases occurred; in 3 families 3 cases occurred. Removal. Forty children were removed to hospital, approximately 32 per cent. All these were admitted to hospitals of the L.C.C. Deaths. Two children died, aged respectively 4 months and 2 years. Measles. During 1935 I received information of 36 cases of measles. Of these 11 were notified by school teachers and 6 by medical practitioners; information of 11 was given by L.C.C. hospital authorities, 6 by health visitors, 2 by parents. Age. Two were under 1 year, 16 were between 1 and 5 years, 11 were between 5 and 16 years, and 7 were over 16. Spread in Family. The 36 cases occurred in 34 families. In 2 families 2 cases occurred. Removals. Fifteen patients were removed to L.C.C. Infectious Diseases Hospitals. Measles Control in Schools. The special arrangements of the London County Council for securing through the school organisation earlier information of measles was continued. 83 German Meatles. During the year information was received relating to 9 cases; 1 was notified by a doctor information of 1 case was received from a school, and 7 from L.C.C. hospitals. A get. One was between 1 and 5 years; 2 were between 5 and 16 years and 6 were over 16 years. Removals. Seven patients were removed to hospital; 5 to the London Fever Hospital and 2 to the L.C.C. Infectious Diseases Hospitals. Diarrhæa and Enteritis under 2 years. The number of deaths was four; all occurred under 1 year of age (see table on page 79). Nursing Arrangements. The services of the district nurses were used as follows in 1935:—Deficient lactation 1 case, 6 visits; complications after pregnancy 1 case, 10 visits; maternity nursing 6 cases, 77 visits. Minor Ailments. The Minor Ailments Clinic has been carried on as usual on Tuesday and Friday afternoons. Ninety-five patients attended the clinic making 245 attendances. The principal ailments treated were as follows:— Conjunctivitis and blepharitis 18 Sores, including sore buttocks 35 Aural discharge 20 Stomatitis 6 Umbilical hernia, strapping 29 Impetigo 12 Attention to breast and nipples 9 Post-Vaccination dressings 13 Tonsils 8 Constipation 12 Warts 8 Also, in smaller numbers: — Slight septic conditions of leg, finger, hand, arm and gums; attention to varicose veins. F 2 84 Routine Medical Inspection of Elementary School Children in Holborn, 1935. Age Groups. Number examined. Clothing and Boots. Nutrition Cleanliness of Head. Cleanliness of Body. Teeth. Vision. Good Fair. Poor. Good. Average. Below normal. Bad. Clean. Nits. Pediculi. Clean. Dirty. Pediculi. All sound. Less than four decayed. Four or more decayed. 6/6 in both eyes. 6/9 in either or both eyes. 6/12 or worse in either or both eyes. Entrants— Boys 143 25 117 1 36 89 18 — 139 4 — 140 3 — 93 50 — — — — Girls 155 87 118 — 42 93 20 — 146 9 — 150 5 — 109 46 — - — — Age 7— Boys 117 12 105 — 16 69 30 2 113 4 — 114 3 — 90 24 3 49 52 13 Girls 111 17 94 — 27 73 11 — 94 17 — 103 8 — 76 32 3 35 60 16 Age 11— Boys 178 10 168 — 29 123 26 — 172 6 — 168 10 — 141 30 2 105 38 35 Girls 164 15 148 1 30 109 25 - 149 14 1 158 6 — 137 27 — 90 37 36 Age 14— Boys 185 44 141 — 49 112 24 — 179 6 — 181 4 — 152 33 — 106 46 33 Girls 178 51 127 — 60 101 17 — 163 15 — 173 5 — 146 32 — 109 32 37 Total 1,231 211 1,018 2 289 769 171 2 1,155 76 1 1,187 44 — 944 279 8 494 265 170 Percentage 17.1 82.7 0.2 23.5 62.5 14.0 93.8 6.1 6.1 96.4 3.6 0.0 76.7 22.7 0.6 63.2 28.5 18.3 London 54.2 45.3 0.5 17.4 76.9 5.7 97.2 2.5 0.3 99.0 0.9 0.1 68.9 27.0 4.1 66.4 19.0 14.6 85 Examination of Elementary School Children in Holborn in 1935. Defect. Boys. Girls. Entrants Age 7 Age 11 Age 14 Entrants Age 7 Age 11 Age 14 Number Examined 143 117 178 185 155 111 164 178 Cases * Cases * Case. * Cases * Cases * Cases * Cases * Case. * Malnutrition 9 9 6 5 3 3 1 1 5 5 2 2 2 2 — — Skin Disease — — 2 2 — — 3 — — — 1 1 — — — — Dofective Teeth — 49 — 27 — 36 — 32 — 45 — 35 — 24 — 32 Enlarged Tonsils 35 12 14 5 13 4 7 1 36 11 18 9 16 2 14 4 Adenoids 1 1 1 — 1 — 1 1 1 - - - - - - - Enlarged Tonsils and Adenoids 1 1 - - - - - - - - - - - - - - Other Nose and Throat Defects 9 3 5 1 1 — - — 2 1 1 - - - - - Enlarged Glands — — — — — — — — 3 1 1 - - - - - Eye Disease 5 4 5 2 4 3 6 1 10 8 2 1 1 — 6 4 Vision Defect — — — 9 — 22 — 24 — — — 9 — 28 — 32 Otorrhæa 2 2 — — 2 2 1 1 1 1 — — 1 1 5 5 Other Ear Disease 1 - - - - - - - - - - - - - - - Defective Hearing — — — — 1 — 1 — — — — — 2 2 1 — Speech Defects — — 1 — 2 — 1 — — — — — — — — — Heart Defects 3 — 4 — 1 — 2 — 2 — 2 — 5 — 2 — Anæmia 5 — 2 1 8 4 4 2 2 — 4 — 2 1 2 — Lung Defects 4 4 3 — 3 1 — — 11 2 4 2 1 1 1 1 Nervous Defects — — 2 1 — — — — 2 — — — 2 1 2 — Phthisis — — — — — — — — I 1 - - - - - - Other T.B. Disease - - - - - - - - - - - - - - - - Rickets 2 — — — — — 1 — 1 — — — — — — — Spinal Deformities — — — — 1 — 1 — 1 1 — — 3 — 6 — Other Deformities 1 — — — 2 1 1 — 1 — 1 — 2 1 2 1 Other Defects 7 5 6 — 6 3 2 1 3 2 6 3 3 — 7 2 Number of Children noted for treatment 76 46 63 67 61 52 58 66 Defects, however slight, are included under " Cases." Those severe enough to require treatment are shown under *. 86 Infant Life Protection. On the 1st January, 1935, two foster mothers remained on the register. During the year one other was added to the register and two were removed; leaving one registered foster mother in the Borough at the 31st December, 1935. The removals were for the following reasons: — Child removed to the care of parent 1 Child removed from Register on reaching the age of nine 1 Under the arrangement made with the London County Council the School Care Committee is notified when a foster child reaches the age of nine years, at which age supervision under the Children Acts ceases. Notification is also sent to the Medical Officer of Health of the district concerned when foster children are removed into another area to the care of the parent, to another foster mother, or with the same foster mother. Applications are received from time to time from parents and others desirous of placing children with suitable foster mothers, but much difficulty is experienced in finding suitable homes where foster children can be received. In some cases it has been possible to effect satisfactory arrangements for the purpose through the co-operation of the Child Guidance Council. Birth Control. Arrangements were made for contraceptive advice to be available for married women attending the Council's Centres in cases where further pregnancy would be injurious to health. The advice is to be given only where recommended by the Medical Officers of the Centres and approved by the Medical Officer of Health. The facilities offered by a voluntary birth control clinic are to be utilised and a small fee per case (5s.) will be paid by the Council. No case was referred for such advice in 1935. Health and Baby Week. Health Week, with which Baby Week was combined, was observed in the Borough during the week 6th to 12th October, 1935. With a view to economy the programme was limited to the following: — Co-operation with the School Organisations. Arrangements were made for children attending elementary schools in the Borough to write answers to a series of questions, on health topics, prizes being awarded to the girl and boy writing the best answers in each school. The questions 87 were divided into two sets, one for children in senior departments and one for those attending junior departments The Mayor and Mayoress (Councillor and Mrs. W. E. Mullen) kindly entertained to tea the prize winners and four other children from each school (two girls and two boys) whose answers were adjudged as next best to those of the prize winners. We are much indebted to the Head Teachers and staffs of the various schools for their invaluable help and co-operation. It is they who establish in the minds of the children an interest in health. Health Poster Designs. Children in the elementary schools were also again invited to enter a competition in the designing of health posters. Seventy-five designs were submitted from six schools. One prize was awarded to a pupil of St. George-theMartyr School. Arrangements were made for children to see the posters at various schools. Meeting for Mothers. Following the usual custom during Health and Baby Week, the Thursday afternoon class at the John Street Centre, was made the occasion of a special address and of a distribution of certificates. The Mayor and Mayoress (Councillor and Mrs. W. E. Mullen) presided and kindly distributed the certificates of congratulation to those whose children had attended the Centre from early infancy until the age of five years; also to those who had recently beecome entitled to certificates for completing attendances for active immunisation against diphtheria. Miss Marjorie Abrahams, of the Diet Department, St. Bartholomew's Hospital. spoke on "Food for Young Children." There was a good attendance, and the address was much appreciated. SANITARY ADMINISTRATION. Public Mortuary. The Public Mortuary provided by the Council is situated in Goldsmith Street. During the year 51 bodies were deposited. There were 44 post-mortem examinations made, and 3 inquests held. On 4 occasions bodies awaiting burial were removed to the mortuary on account of inadequate accommodation in the homes. Thirty-nine bodies were brought in by order of the Coroner, and 8 by the Police. 88 Inquests. During the year 34 inquests were held on the bodies of Holborn parishioners. Many of these died outside the Borough and the inquests were held in the districts where death took place, the deaths being subsequently transferred to Holborn. The causes of death certified as a result of such inquests were :—Natural causes, 8; Accidents, 9; Suicide, 14; Misadventure, 2; Open Verdict, 1. The causes of death certified were as follows: — Natural Causes. Accidents. Alcoholism 4 Falls 2 Other causes 4 Street accidents 3 Burns and scalds 2 Crushed by machinery 1 Misadventure. Crushed by lift 1 Want of attention at birth 1 Self induced abortion 1 Suicide. Coal gas poisoning 9 Hanging 1 Open Verdict Jump from window 1 Septic Miscarriage 1 Narcotic poison 3 The Removal of Aged, Infirm and Diseased Persons. Power to deal with this matter is given by the London County Council (General Powers) Act, 1928. During the year six cases of aged and infirm persons were brought to our knowledge and were visited to see if action was necessary and desirable under this Act. As a result of the visits all such persons were removed to institutions; in one case arrangements were made for the care of the aged person by nurses from a local organsition, and in one case the conditions were not such as to call for action under this Act. Rent and Mortgage Interest Restriction Acts, 1920 to 1933. No application was received during the year for a certificate under the above Acts. 89 Nuisance from Pigeons. London County Council (General Powers) Act, 1927. During the year several requests were received for steps to be taken to reduce the number of pigeons frequenting the precincts of buildings in the Borough. The arrangements made in the previous year were continued under which two members of the Health Department staff endeavour to trap the birds. Successful operations were carried out by them on various occasions at five different sites frequented by pigeons and, in all, 375 birds were caught. This number included 118 birds caught in Lincoln's Inn Fields. It must, however, be recorded, that on many occasions in Lincoln's Inn Fields, even after several hours work, no birds were caught. In open spaces such as this pigeon trappers are handicapped by members of the public who regularly feed the birds and who endeavour to prevent the effective use of the trapping nets. It is not desired to destroy all wild pigeons in Central London, but it is desirable that the number should be kept within reasonable limits. Demolition of Old Buildings. The London County Council (General Powers) Act, 1927, gave power to that Council to make By-laws in relation to the demolition of old buildingB. By-laws dealing with the subject were made by the London County Council in July, 1929, and were approved by the Minister of Health on the 14th November, 1929. These By-laws are enforceable by the Metropolitan Borough Councils. We are informed by the Borough Engineer's Department of licences issued for the erection of hoardings for the purpose of the demolition of buildings, and the sites are then visited by the Sanitary Inspectors concerned. Propaganda. Health propaganda work was continued during the year, and included the following: — A. Lectures arranged in co-operation with the British Social Hygiene Council, namely:— (i) "Answering Children's Questions." This lecture was given by Dr. Naomi Dancy, and the Deputy Mayor (Alderman Albert A. Mussett) presided. (ii) A lecture by Dr. I. Feldman on " The problems of the growing boy and girl." The Worshipful the Mayor (Councillor Wilfred E. Mullen, J.P.) presided at this lecture. 90 Films were shown illustrating both lectures, and on each occasion there was a satisfactory attendance. B. Three talks for mothers were arranged, also in co-operation with the British Social Hygiene Council. These were on: — " The handling of small children." " How to answer the questions of little children and adolescents." The talks were very much appreciated by the mothers, who showed the importance they attached to the subjects by attending in increasingly large numbers. C. Various health posters were exhibited, including a selection of such propaganda matter supplied by the Health and Cleanliness Council. D. An Empire Marketing Board frame taken over by the Council for propaganda purposes was kept supplied with a variety of suitable matter. 91 APPENDIX. TABLE I. Vital Statistics of Whole District during 1935 and Ten Previous Years Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District Transferable Deaths Net Deaths belonging to the District. Under 1 Year of Age At all Ages Uncorrected Net Number of Nonresidents registered in the District of Residents not registered in the District Number Rate per 1,000 Births Number Rate. Number Number Rate 1926 43,315 364 527 12.16 725 513 330 33 63 642 12.5 1926 43,200 330 635 12.38 629 454 347 48 90 622 12.1 1927 42,209 320 605 11.96 728 531 333 19 38 530 12.5 1928 39,280 301 473 12.0 739 546 338 27 57 531 13.5 1929 38,380 256 392 10.21 766 645 377 29 74 698 16.6 1930 38,880 256 405 10.05 693 s23 318 36 89 488 12.7 1831 34,470 211 352 10.21 787 598 303 26 74 492 14.3 1932 36,410 186 349 957 773 607 351 26 72 617 14.2 193s 36,050 180 312 949 681 621 326 24 70 486 13.6 1934 36,000 150 309 8.58 699 552 293 22 71 440 12.2 1935 35,400 134 271 7.65 668 526 278 24 88 420 12.7 In the above table the birth-rates and death-rates are calculated on the RegistrarGeneral's estimates of resident population as at the middle of each year. 92 TABLE II. Causes of, and Ages at, Death, 1935. Causes of Death. NET DEATHS AT THE SUBJOINED AGES OF " RESIDENTS," whether occurring within or without the Borough. Total Deaths whether of "Residents " or " NonResidents' in Institutions in the Borough. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and under 75 years. 75 and upwards. All causes Certified 120 24 2 2 7 9 34 189 116 87 Uncertified ... ... ... ... ... ... ... ... ... ... 1. Typhoid and Paratyphoid Fevers ... ... ... ... ... ... ... ... ... ... ... 2. Measles ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... 4. Whooping Cough 2 1 ... 1 ... ... ... ... ... ... 1 5. Diphtheria 2 ... ... ... 1 1 ... ... ... ... ... 6. Influenza 3 ... ... ... ... ... ... 1 2 ... 3 7. Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... 8. Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... 5 9. Tuberculosis of Inspiratory System 29 ... ... ... 1 3 7 12 6 ... 11 10. Other Tuberculous Diseases 1 ... ... ... 1 ... ... ... ... ... 18 11. Syphilis 5 ... ... ... ... ... ... 5 ... ... ... 12. General Paralysis of the insane, Tabes Dorsalis 5 ... ... ... ... ... 1 4 ... ... ... 13. Cancer, malignant disease 58 ... ... ... ... ... 3 31 15 9 59 14. Diabetes 5 ... ... ... ... ... ... 3 2 ... 7 16. Cerebral Haemorrhage 19 ... ... ... ... ... 1 6 6 7 27 16. Heart Disease 113 ... ... ... ... ... 4 24 44 41 30 17. Aneurysm 1 ... ... ... ... ... ... ... 1 ... 2 18. Other Circulatory Diseases 23 ... ... ... ... ... ... 1 11 9 4 19. Bronchitis 16 ... ... ... ... ... 2 4 6 4 5 20. Pneumonia (all forms) 32 6 2 1 ... ... ... 14 7 2 57 21 Other Respiratory Diseases 2 1 ... ... ... ... ... ... ... 1 19 22. Peptic Ulcer 7 ... ... ... ... ... 1 4 2 ... 4 23. Diarrhoea, etc. (under 2 years) 7 4 ... ... ... ... ... 1 1 1 47 24. Appendicitis 1 ... ... ... ... ... ... I ... ... 13 25. Cirrhosis of Liver 4 ... ... ... ... ... ... 3 ... 1 2 26. Other diseases of liver, etc 2 ... ... ... ... ... ... ... 1 1 2 27. Other digestive diseases 6 ... ... ... ... ... 1 2 2 ... 15 28. Acute and Chronic Nephritis 3 ... ... ... ... ... ... 2 ... 1 22 29. Puerperal Sepsis 1 ... ... ... ... 1 ... ... ... ... ... 30. Other Puerperal Causes ... ... ... ... ... ... ... ... ... ... ... 31. Congenital Debility, Premature Birth, Malformation, etc. 11 11 ... ... ... ... ... ... ... ... 52 32. Senility 4 ... ... ... ... ... ... ... 1 3 ... 33. Suicide 14 ... ... ... ... ... 5 9 ... ... 3 34. Other Violence 10 1 ... ... 1 2 1 2 2 1 9 35. Other Defined Diseases 35 ... ... 3 2 6 10 8 6 115 36. Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... 420 24 2 2 7 9 34 189 116 87 532 93 TABLE III. Cases of Infectious Disease notified during the year 1935. Disease. Total Under 1 l to 2 2 to 3 3 to 4 4 to 6 6 to 10 10 to 16 15 to 20 20 to 36 35 to 46 46 to 65 65 up Total Deaths Small-pox ... ... ... ... ... ... ... ••• ... ... ... ... ... ... Diphtheria 93 1 2 7 14 8 27 12 5 13 2 2 ... 2 Erysipelas 18 ... ... ... ... ... 1 ... 1 3 2 7 4 2 Scarlet Fever 50 ... 4 5 5 8 11 6 4 7 ... ... ... ... Enteric Fever 2 ... ... ... ... ... ... ... 1 1 ... ... ... ... Puerperal Fever 4 ... ... ... ... ... ... ... ... 3 1 ... ... ... do. Pyrexia 4 ... ... ... ... ... ... ... 1 2 1 ... ... 1 Cerebrospinal Fever 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Ophthalmia Neonatorum 4 4 ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 6 ... ... ... ... ... 2 1 ... ... 1 2 ... 1 Malaria 3 ... ... ... ... ... ... ... ... 3 ... ... ... ... Pneumonia—Primary 19 ... 2 ... 1 4 1 1 ... 1 1 4 4 2 do. Influeuzal 2 ... ... ... ... ... ... ... ... 2 ... ... ... Tuberculosis— Pulmonary 68 ... ... ... ... ... 1 6 1 31 13 10 7 36 do. Non-Pulmonary 5 ... ••• ... ... ... 2 1 ... 1 ... 1 ... 2 Whooping Cough 99 12 17 11 12 12 30 5 ... ... ... ... ... 1 Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... Rheumatism 2 ... ... ... ... ... 1 1 ... ... ... ... ... ... 381 17 25 23 33 32 76 32 14 67 21 26 15 47 TABLE IV. INFORMATION REQUIRED BY THE LONDON COUNTY COUNCIL. PREMISES. Number in Borough at end of 1935. Number of Inspections. Number of Prosecutions. Common Lodging House 4 33 ... Cowsheds ... ... ... Milkshops 152 207 ... Registered houses let in lodgings 460 739 ... Ice cream premises 25 26 ... Slaughter-houses 1 11 ... Offensive Trades ... ... ... Restaurants and Eating Houses 309 464 ... Registered foster mothers 1 27 ... Nurse children kept 1 Total number of houses in the Borough 6,462 (Census 1931) Number of houses occupied by the working classes 3,832 Public Health Act— Number of houses inspected on account of complaints or illness 468 Number of statutory notices served 45 Number of houses repaired or nuisances remedied 223 Housing Acts (1925-35)— Number of houses inspected—house to house (Housing Consolidated Regs. 1925) 66 Number of houses included in representations by the Borough Medicil Officer under Section 1, Housing Act, 1930 — Number of houses demolished following representations by Borough Medical Officer under Section 1 of Housing Act, 1930 — Number of houses repaired under Section 17 and 18 of Housing Act, 1930— (a) by owners 9 (b) By L.A. in default of owners — Number of houses demolished— (а) in pursuance of orders under Section 19 of the Housing Act, 1930 3 (б) Voluntarily 15 Number of houses (wholly or in part) the subject of Closing Orders (exc. underground rooms) 1 Number of Closing Orders determined (i.e. houses made fit) — Number of houses in accepted schemes for re-development or re-conditioning by owners under Part V of the Housing Act 1935 — Number of certificates of fitness issued under Section 55 of the Housing Act, 1935 — Number of houses ertcted by the Borough Council for working classes during year — Houses Let in Lodgings— Number registered in Borough 460 Number of inspections 739 Number of prosecutions — Number of complaints remedied under the Bye-laws (not included under any other heading) 31 Underground Rooms— Number occupied but unfit under Section 18 of the Housing Act, 1925 as modified by Section 84 of the Housing Act, 1935 583 Number closed or modified occupation approved under Section 84 of the Housing Act, 1935 2 Overcrowding (Housing Act, 1935)— Number of houses inspected under Section 1 of the Housing Act, 1935 3,832 Number of families found to be living in overcrowded conditions Section 1 of Housing Act, 1935 700 Smoke Nuisances— Number of observations 82 Number of notices 5 Number of complaints 4 Number of summonses — Cleansing and Disinfection— Number of adults cleansed 131 Number of children cleansed — Number of premises disinfected :— (a) After infectious diseases 260 (b) For vermin 97 Water Supply to Tenement Houses— Number of premises supplied 2 Number of prosecutions — Sanitary Officers— Number of Sanitary Inspectors (whole-time) Male 4 Female — Number of Sanitary Inspectors (part-time) Male — Female 1 95 TABLE V. Factories, Workshops, Laundries, Workplaces and Homework 1.—INSPECTION. Including Inspections made by Sanitary Inspectors. PREMISES. Number of Inspections. Written Notices. Prosecutions. Intimations. Statutory. Factories 446 20 2 ... Workshops 347 36 3 ... Workplaces 4,179 99 15 ... Total 4,972 155 20 ... 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to h.m. Inspector. Nuisances under the Public Health Acts: Want of cleanliness 41 41 ... ... Want of ventilation 9 9 ... ... Overcrowding 1 1 ... ... Other nuisances 93 93 ... ... Sanitary accommodation insufficient 7 7 ... ... unsuitable or defective 49 49 ... ... not separate for sexes 4 4 ... ... Offences under the Factors and Workshop Act: Illegal occupation of underground bakehouse (S. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (SS. 97 to 100) ... ... ... ... Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) ... ... ... ... Total 204 204 ... ... * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 96 TABLE V.—continued. 3.—HOME WORK. NATURE OF WORK. Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises. Sections 109, 110. Lists received from Employers. Notices served on occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served Prosecutions. Instances Orders made (S. 110). Prosecutions (Sections 109, 110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel— Making, &c. 88 235 144 1 ... 8 88 ... ... ... ... ... ... ... ... Paper Bags and Boxes 2 ... 12 ... ... ... 2 ... ... ... ... ... ... ... ... Total 90 235 156 1 ... 8 90 ... ... ... ... ... ... ... ... 97 TABLE V.—continued. 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. (1) Number. (2)[/##] Bakehouses (including 13 factory bakehouses) 19 Other Workshops 619 Total number of workshops on Register 638 5.—OTHER MATTERS. Class. (1) Number. (2)[/##] Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 3 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 5) Notified by H.M. Inspector 16 Report (action being taken) sent to H.M. Inspector 15 Other — Underground Bakohouses (S. 101):— Certificated granted during the year — In use at the end of the year 11 98 LEGAL PROCEEDINGS. Food and Drug's (Adulteration) Act, 1928. Date. Name. Address. Offence. Result. 1935 Jan. 10th Thomas Jones 67, Gray's Inn Road Selling milk 6% deficient in fat Warranty proved. Summons dismissed. May 28th P. Nelson Bogh 46, Wynford Road, N. 1 Selling milk 25.3% deficient in fat Summons withdrawn on payment of £1. 1s. costs. Oct. 1st Edwin Edwards 87, Leather Lane Selling milk 6% abstracted fat Defendant convicted Fined 40s. and 21s. costs.